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Property of the 

Lancaster City and County 
Medical Society 













VOL. V. 





Entered according to Act of Congress, in the 3^ear 1843, by 


In the office of the Clerk of the District Court for the Eastern District of 





Communications have been received from Professor Gardner, Drs. Kmg, 
Wiiarton, Harden, Young, Shipman, and Earle. 

Tiie following works have been received: — 

A case of Carcinomatous Stricture of tiie Rectum, in which the descending- 
colon was opened in the loin. By Alfred Jukes, Surgeon to the General Hos- 
pital, Birmingham. With plates. London, 1842, 4to. (From Dr. W. C. Roberts.) 

The History, Diagnosis, and Treatment of Typhoid and of Typhus Fever; 
with an Essay on the Diagnosis of Bilious, Remittent, and of Yellow Fever, 
By Elisha Bartlett, M. D., Professor of the Theory and Practice of Medicine 
in Transylvania University. Philadelphia, Lea & Blanchard, 1842. (P'rom the 

The Evolution of Light from the Living Human Subject. By Sir Henry 
Marsh, Bart., M. D., M. R. L A., &c. &c. &c. Dublin, 1842. (From the au- 

The London Dissector, or Guide to Anatomy; for the use of students; com- 
prising a description of the muscles, vessels, nerves, lymphatics, and viscera of 
the human body, as they appear on dissection; with directions for their demon- 
stration. From the last London edition. Revised and corrected by E. J. Chaisty, 
M. D., late Demonstrator of Anatomy in the University of Maryland. Phila- 
delphia, Barrington & Haswell, 1842. (From the publishers.) 

Clinical Aphorisms: a contribution towards the history and treatment of the 
Endemic Bilious Fever of the Eastern Shore of Maryland; designed for the use 
of the young practitioner. By Peregrine Wroth, M. D., Honorary Member of 
the Philadelphia Medical Society. Chestertown, Maryland, 1842. (From the 

An Essay on Diabetes. By H. Bell, D. M. P., one of the Librarians of the 
Faculty of Medicine of Paris. Translated by Alfred Marckwick, late Ex- 
terne to the Hopital des Veneriens. Paris, &c. &c. London, 1842. (From the 

A System of Human Anatomy, General and Special. By Erasmus Wilson, 
M. D., Lecturer on Anatomy. London. American edition edited by Paul B. 
GoDDARD, A. M., M. D., Demonstrator of Anatomy in the University of Penn- 
sylvania, &c. &c. &c.; with one hundred and seventy illustrations by Gilbert. 
F^rom the second London edition. Philadelphia, Lea & Blanchard, 1843. (From 
the publishers.) 

Quarterly Summary of the Transactions of the College of Physicians of Phi- 
ladelphia, August, September, October, 1842. (From the College.) 

Medical Students' Guide; being a compendious view of the Collegiate and 
Clinical Medical Schools, the courses of private lectures, the hospitals and 
almshouses, and other institutions which contribute directly or indirectly to the 
great Medical School of Philadelphia; with tbe regulation of hours, fees, &c., 
and other information of importance to Students. 1842-3. By Heber Chase, 
M. D. Philadelphia, J. G. Auner, 1842. (From the author,) 

Observations on the Epidemic Yellow Fever of Natchez and of the South- 
west. By John W. MoNETTE, M. D. Louisville, Ky., 1842. (From the author.) 

Remarks on Medical Reform, in a letter addressed to the Right Hon. Sir James 
Graham, Bart., one of her majesty's principal Secretaries of State. By Sir 
James Clark, Bart., M. D., Y. R. S., Physician in ordinary to the Queen, and 
to the Prince Albert. London, 1842. (From the author.) 


General Therapeutics and Materia Medica, adapted for a text book. By Rob- 
ley DuNGLisoN, M. D.. Professor of the Institutes of Medicine, &c. in Jefferson 
Medical College, 2 vols. 8vo. Philadelphia, Lea & Blanchard, 1843. (From 
the publishers.) 

Introductory Lecture to the Course of Medical Institutes in the University of 
Pennsylvania. Delivered, November 4, 1842. By Samuel Jackson, M. D. 
Philadelphia, 1842. (From the author.) 

Some Account of the Origin and Present Condition of the Medical Institute 
of Louisville, with remarks on a late rejected report. Louisville, Ky., 1842. 

Introductory Lecture to the Course of Instruction in the Medical Institution 
of Geneva College, (upon the occasion of opening a new building, 4th October, 
1842.) By Thomas Spencer, M.D., Dean, Professor of the Institutes and 
Practice of Medicine. Geneva, 1842. (From the author.) 

Physician for Ships; containing medical advice for seamen, and other persons 
at sea, on the treatment of diseases and on the preservation of health in sickly 
climates. By Usher Parsons, M. D., late Surgeon in the United States Navy, 
President of the Rhode Island Medical Society, &c. &c. Third Edition. Boston, 
1842. (From the author.) 

Contributions to the History and Diagnosis of Croup. By John Ware, M.D. 
Boston, 1842. (From the author.) 

Report of the Joint Special Committee on the subject of the Effects of Lead 
Pipes upon Well-water in the city of Lowell. Lowell, 1842. (From John W. 

An Elementary Treatise on Auscultation and Percussion, or the Application 
of Acoustics to the Diagnosis of Diseases, with a Synoptical Table. By A. 
Raciborski, M. D. Translated, with notes, &c., by Minturn Post, M. D. 
New York, Collins, Keese & Co., 1839. (From Collins, Brother & Co.) 

Elements of Physiology. By J. Muller, M. D., Professor of Anatomy and 
Physiology in the University of Berlin. Translated from the German by Wil- 
liam Baly, M. D. Arranged from the second London edition by John Bell, 
M. D., Lecturer on Materia Medica and Therapeutics, &c. Philadelphia, Lea 
& Blanchard, 1843. (From the Publishers.) 

The Good Physician: being an Introductory to the course of Lectures on Ma- 
teria Medica and Therapeutics in the Medical Department of Transylvania Uni- 
versity, for the session of 1842-3. By Thomas D. Mitchell, M. D., Professor, 
&c. &c. Published by the Medical Class. Lexington, Ky., 1842. (From the 

Observations on the Admission of Medical Pupils to the Wards of Bethlehem 
Hospital, for the purpose of studying Mental Diseases. Third edition revised. 
By John Webster, M. D., &c., one of the Governors. London, 1842. (From 
the author.) 

A Treatise on the Diseases of the Eye. By William Lawrence, F. R. S., 
&c. &c. From the last London edition, with numerous additions, and sixty illus- 
trations. By Isaac Hays, M. D., Surgeon to Wills Hospital, &c. &c. Phila- 
delphia, Lea & Blanchard, 1843. (From the publishers.) 

Introductory Lecture to the course of Medical Institutes in the University of 
Pennsylvania. Delivered November 4, 1842. By Samuel Jackson, M. D. 
(From the author.) 

On certain Medical Delusions: an Introductory Lecture to the course of Insti- 
tutes of Medicine in Jefferson College. Delivered November 4,1842. By 
RoBLEY Dunglison, M. D. (From the author.) 

On the Usefulness of the Medical Profession, beyond the limits of the Pro- 
fession: a lecture introductory to the course of Practice of Medicine in Jefferson 
Medical College of Philadelphia. Delivered November 4, 1842. By J. K. 
Mitchell, A. M., M. D. (From the author.) 

On Recent Improvements in Surgery; an Introductory Lecture to the course 
on the Principles and Practice of Surgery in Jefferson Medical College of Phi- 
ladelphia. Delivered November 3, 1842. By Thomas D. Mutter, M. D., 
Philadelphia, 1842. (From the author.) 


The Prescribers Pharmacopoeia: containing all the Medicines in the London 
Pharmacopcsia, arranged in classes according to their action, with their compo- 
sition and doses. Revised and improved by an American Physician. New 
York. Samuel S. & Wm. Wood, No. 261 Pearl St., 1842. (From the pub- 

The Obstetric Catechism: By Joseph Warrington, M. D. Philadelphia, 
J. G. Auner, No. 333 Market Street, 1842. (From the Publisher.) 

The Northern Lakes a summer residence for invalids from the South. By 
Daniel Drake, M. D. Professor in the Medical Institute of Louisville. Louis- 
ville, 1842. (From the author.) 

A Practical Treatise on Venereal Diseases; or critical and experimental re- 
searches on inoculation, applied to the study of these affections, with a thera- 
peutical Summary and Special Formulary. By Ph. Record, M. D. Surgeon to 
the Venereal Hospital of Paris, &c. &c. Translated from the French by Henry 
PiLKiNGTON Drummond, M. D. Philadelphia, Lea & Blanchard, 1843. (From 
the publishers.) 

Lectures on the Diseases of the Urinary Organs. By Sir Benjamin C. Brodie, 
Bart., F. R. S. Surgeon to the Queen. From the third London Edition with 
alterations and additions. Philadelphia, Lea & Blanchard, 1843. (From the 

The Principal Diseases of Females, together with the diseases incident to 
pregnancy and childbed, chiefly for the use of Students. By Fleetwood 
Churchill, M. D., Lecturer on Midwifery and Diseases of Women and Chil- 
dren, in the Richmond Hospital, School of Medicine, &c. &;c., with Notes and 
additions by R. M. Huston, M. D., Professor, &c. in the Jefferson Medical 
College. Second American Edition, in 1 vol. 8vo. — Lea & Blanchard, 1843. 
(From the publishers.) 

Zeitschrift fiir die gesammte Medicin mit hesonderer Riicksicht aux Hospital — 
praxis und auslandische Literatur Herausgegeben von F. W". Oppenheim, April, 
May, June, July, 1842. (In exchange.) 

Archief voor geneeskunde. Ouder medewerking van eenige vaderlaudische 
gelcerden, vitgegeven door Dr. J. P. Heije. Amsterdam. (From Dr. Oppen- 

The India Journal of Medical and Physical Science. Edited by Frederick 
CoRBYN, Esq. October, November, December, 1841, January, February, 1842. 
(In exchange.) 

The India Review and Journal of Foreign Science and the Arts. Edited by 
Frederick Corbyn, Esq. September, November, December, 1841. (In ex- 

The Medico-Chirurgical Review and Journal of Practical Medicine, October, 
1842. (In exchange.) 

The Edinburgh Medical and Surgical Journal, October, 1842. (In exchange.) 

The British and Foreign Medical Review and Quarterly Journal of Practical 
Medicine and Surgery, October, and November, 1842. (In exchange.) 

The London Medical Gazette, July, September, 1842. (In exchange.) 

The London and Edinburgh Monthly Journal of Medical Science, September, 
October, and November. (In exchange.) 

The Provincial Medical and Surgical Journal and Retrospect of the Medical 
Sciences. October, and November, 1842. (In exchange.) 

Dublin Medical Press, Sept., October, and November, 1842. (In exchange.) 

The New England Quarterly Journal of Medicine and Surgery, October, 1842. 
(In exchange.) 

The American Journal of Science and the Arts, Oct., 1842. (In exchange.) 

The Western Lancet, September, and October, 1842. (In exchange.) 

The Medical Examiner, October, November, and December, 1842. (In ex- 

The Western Journal of Medicine and Surgery, September, October, and No- 
vember, 1842. (In exchange.) 

The American Journal of Pharmacy, October, 1842. (In exchange.) 


The Western Lancet, devoted to Medical and Surgical Science. Edited by 
L. M. Lawson, M. D. October and November, 1842. (In exchange.) 

The New York Lancet, October, November, and December, 1842. (In ex- 

The American Journal and Library of Dental Science. Published under the 
auspices of the American Society of Dental Surgeons. September, 1842. (In 

The Select Medical Library (New Series) and Bulletin of Medical Science. 
Edited by John Bell, M.D.,&c. &c. October, 1842. (In exchange.) 

Communications intended for publication, and Books for Review, should be 
sent, free of expense, directed to Isaac Hays, M. D., Editor of the Amer. Journ. 
of Med. Sci., care of Messrs. Lea & Blanchard, Philadelphia. Parcels directed 
as above, and sent (carriage paid) under cover, to John Miller, Henrietta Street, 
Covent Garden, London, or to Wiley & Putnam, New York, or W. D. Ticknor, 
Boston, will reach us safely. We particularly request the attention of our 
foreio-n correspondents to the above, as we are often subjected to unnecessary 
expense for postage and carriage. 

All remittances of money, and letters on the business of the Journal, should be 
addressed exclusively to the publishers, Messrs. Lea & Blanchard. 

jjy* The advertisement sheet belongs to the business department of the 
Journal, and all communications for it should be made to the publishers, 
under whose exclusive control it is. The editor does not even revise the proof 







JANUARY, 1843. 



I. Report of Surgical Cases treated at the Pennsylvania Hospital. By 
Geo. W. Norris, M. D., one of the Surgeons. - - - - - 13 

II. Practical Observations on Chorea. By Charles C. Hildreth, M. D., of 
Zanesville, Ohio. _._-____. -31 

III. An Inquiry into the Pathology and Treatment of Varices. By John 
Watson, M. D., one of the Surgeons to the New York Hospital. - 36 

IV. Remarks upon the cases of Smallpox ad nnltted into the City Hospital 
during the years 1840, 41, and 42. By Thos. Slewardson, M. U., Phy- 
sician to the Institution. - - - - - - - - -81 

V. A Nasal Operation for the removal of a large tumour filling up the entire 
nostril and extending to the Pharynx. By Valentine Molt, M. D. [With 
two wood-euts.n _-__-. --.-87 

VI. On the Meteorology of Hemorrhage. By B. F. Joslin, M. D., of the 
City of New York. 92 

VII. Plastic Operations. By J, Pancoast, M. D., Professor of Anatomy in 
Jefferson Medical College. Lecturer on Clinical Surgery at the Phila- 
delphia Hospital. ---_-_. .--99 

VIII. On the Signs of Pregnancy. By T. Romeyn Beck, M. D., Profes- 
sor of Materia Medica in the Albany Medical College. - . - 112 

IX. Remarks on a Species of Sore Mouth peculiar to Nursing Women. By 

B. Waller Taylor, M.D., of Monticello, Florida. - - - -119 

X. Case of death from extensive Intestinal and Peritoneal Inflammation, 
resulting from a perforation of the Intestinal Coats, occasioned by a Cal- 
culus lodged in the Appendix Vermiformis. By J. F. Peebles, M. D., 
Petersburg, Virginia. _-.---_.- 122 


XI. Memoirs of the Life and Vvritings of William P. Dewees, M. D. By 
Hugh L. Hodge, M. D., Professor of Obstetrics in the University of 
Pennsylvania. 128 



XII. Animal Chemistry, or Organic Chemistry in its application to 
Physiology and Pathology. By Justus Liebig, M. D.. Professor of 
Chemistry in the University of Giessen, etc. etc. etc. Edited from the 
author's manuscript, by William Gregory, M. D., Professor of Medicine 
and Chemistry in the fjniversity and King's College, Aberdeen. With 
additions, notes and corrections, by Dr. Gregory, and others, by John W. 
Webster, M. D., Erving Professor of Chemistry in Harvard University. 
Cambridge: Published by John Owen, 1842 — pp. 347. . _ . 145 


XIII. The History, Diagnosis, and Treatment of Typhoid and of Typhus 
Fever; with an Essay on the Diagnosis of Bilious Remittent and of Yel- 
low Fever. By Elisha Bartlett, M. D., Professor of the Theory and 
Practice of Medicine in Transylvania University. Philadelphia, Lea & 
Blanchard, 1842. pp. 395. 165 

XIV. Elements of Physiology. By J. Miiller, M. D., Professor of Ana- 
tomy and Physiology in the University of Berlin, etc. Translated from 
the German, by Wm. Baly, M. D., etc. Arranged from the Second 
London Edition, by John Bell, M. D., etc. 8vo. pp. 886. Philadelphia, 
Lea & Blanchard, 1843. 172 

XV. Quarterly Summary of the Transactions of the College of Physicians 

of Philadelphia, August, September, and October, 1842. - - - 173 

XVI. An Elementary Treatise on Auscultation and Percussion, or the Ap- 
plication of Acoustics to the Diagnosis of Diseases, with a Synoptical 
table. By A. Raciborski, M. D., &c. Translated with notes, &c., by 
Minturn Post, M. D. New York, Collins, Keese& Co., 1839, pp. 261, 

1 plate. -„.„--. 179 

XVII. The Evolution of Light from the Living Human Subject. By Sir 
Henry Marsh, Bart., M. D., &c. &c. &c. Dublin, 1842, pp. 59, 8vo. - 179 

XVIII. A System of Human Anatomy, General and Special. By Erasmus 
Wilson, M. D., Lecturer on Anatomy, London. American edition, edited 
by Paul B. Goddard, A. M., M. D., Demonstrator of Anatomy in the Uni- 
versity of Pennsylvania, &c. &c. &., with one hundred and seventy illus- 
trations by Gilbert. From the second London edition. Philadelphia, 
Lea & Blanchard, 1843, pp. 576, 8vo. - - - - - -180 

XIX. A Treatise on the Diseases of the Eye. By W. Lawrence, F. R. S., 
Surgeon Extraordinary to the Queen; Surgeon to St. Bartholomew's 
Hospital and Lecturer on Surgery at that Hospital; Surgeon to Bethlem 
and Bridewell Hospitals; and late Surgeon to the London Ophthalmic 
Infirmary. From the last London edition. With numerous additions 
and sixty-seven illustrations by Isaac Hays, M,D., Surgeon to Wills 
Hospital, Physician to the Philadelphia Orphan Asylum, Member of the 
American Philosophical Society, &c. &c. &c. Philadelphia, Lea & 
Blanchard, 1843. ».»..,»... iso 







Anatomy and Physiology. 


1 . New Process for Anatomical in- 
jections. By M. Doyere. - 183 

2. Anatomy of the Par Vagum and 
Nervous Accessorius. By Jas. 
Spence, Esq. - - - - 184 

3. On'the Influence of Lactation in 
preventing the occurrence of 
Pregnancy. By T. Laycock, 
M.i). 184 


4. Additional Remarks on Fibrine. 

By Martin Barry. - - - 185 

5. Minute Anatomy of the Spleen. 

M. Bourgery. - - - 186 

6. Nature of the fat substance of 
Milk. By M. Romanet. - 189 

7. Virey's Objections to Liebig's 
Theory of the Uses of Respira- 
tion and of Food. - - - 189 

Materia Medica and Pharmacy. 

8. Observations on Discoloration 
of the Skin from the internal use 
of Nitrate of Silver, and on the 
means of preventing and remov- 
ing that effect. By Charles Pat- 
terson, M. D. - - - 

9. Creasote as a Therapeutic 
Agent. By Dr. Cormack. 



10. Manna 195 

11. Sialogogues. By Dr. Samuel 
Wright. 196 

12. Pharmaceutical Bread. By 
Henry Deane. - - - iqq 

13. Phloridine. - - - 197 

14. Quinine found in the Urine and 

in the blood. By M. Landerer. - 197 

Medical Pathology and Therapeutics and Practical Medicine. 

15. Hypertrophy of the Brain in 
Children. By M. C Lees. - 198 

16. Empyema terminating favour- 
ably by spontaneous opening. 

By Samuel Shortridge, Esq. - 200 

17. Cirrhosis of the Lung. By Dr. 
Stokes. 201 

18. Microscopical characters of the 
sputa in Phthisical Patients. By 

M. Sandras. - - - 201 

19. Treatment of the Hemorrhagic 
Diathesis. By James Miller. - 202 

20. Very simple mode of arresting 

Epistaxis. By M. Negrier. - 203 

21. Prevention of sore nipples. By 
Mr. Marcus. _ - > 203 

22. Deafness cured by the ender- 
mic use of Morphia. By Dr. 
Hoebeke. - - - _ 203 

23. Typhus Fever in an Old Wo- 
man. By M. Rayer. - - 203 

24. Aphthae of the Neck of the 
Uterus. By M. Coute. - 204 

25. On Percussion. By John H, 
Bennett. - - - - 204 




26. Injury to the Elbow-joint in 
Children. By Mr. Sylvester. - 206 

27. Operation for enlarged Patellar 
Bursa. By Dr. Hargrave. - 206 

28. New Remedy for Scalds and 
Burns. By Mr. Wm. Rhind. - 207 

29. Luxation of the Femur in a 
Child three years of age. By 
Mr. J. Kirby. - - - 207 

30. Excision of Joints. By M. 
Roux. 208 

.31. Excision of the Elbow-joint. 
By M. Robert. - - - 208 

32. External Aneurism of Interal 
Carotid Artery. By Jas. Syme. 209 

33. Sudden development of Subcu- 
taneous Tumours. By Mr. Rum- 
ley. - - - - - 211 

34. Fracture of the Clavicle caused 

by muscular action. - - - 212 

35. Gangrene produced by the Im- 
movable Apparatus applied for 
fracture of the fore-arm, in a 
child. 212 

36. On Contusions of Muscles. By 
Wm. Allison. - - - 212 

37. Ununited Fracture treated by 
rubbing ends of fractured bones 
together. By Mr. VVorthington. 214 

38. Urinary Calculus — Lithotrity 
once and Lithotomy twice per- 
formed. By Mr. R. Elliott. - 215 


39. Injectionof infusions of Cubebs 

in Vaginitis. By M. Piorry. - 215 

40. False Joint of the Humerus 
treated successfully by the Se- 
ton. By M. Baroni. - - 215 

41. Spontaneous obliteration of the 
Axillary Artery. By Mr. Oke. 216 

42. Dislocation of the Tibia back- 
wards. By Mr. C. B. Rose. - 216 

43. Cancer. By Dr. Watson. - 216 

44. Femoral Aneurism — operation 

— recovery. By James Syme. 217 

45. Artificial Anus. By Mr. Alfred 
Jukes. - - . - - 218 

46. Retro-pharyngeal Abscess. By 

M. Mondiere. - - - 218 

47. Syphilitic Retraction of the 
Muscles. By M. Ricord. - 219 

48. Treatment of Umbilical Her- 
nia in children. By M. Boucha- 
court. - - - - - 220 

49. Passage of Air into the Veins. 

By Dr. Asmus. - - - 221 

50. Intra-parietal Hernia after a 
Wound of the abdomen. By M. 
Berard. - - - - 221 

51. Case of Strangulated Hernia 
through the foramen thyroideum. 

By Dr. Franlz. - - - 221 

52. Observations on Fibrous Poly- 
pi of the Uterus. By M. Berard. 221 


53. Mechanical Lesions of the 
Eye. By D. O'Beirne. - 222 

54. Wounds of the Supra-ciliary 
Region. By M. Constatt. - 222 

55. Exophthalmia, with (Edema of 
the Conjunctiva, and Opacity of 
the Crystalline Lens in a Puer- 

peral Woman. By M. Blandin. 223 

56. Treatment of Leucoma by In- 
cisions into the Cornea. By D. 
Holscher. - . - . 223 

57. Local employment of Calomel 
in Ophthalmic Neonatorum. By 

Dr. Kluge. - - - - 224 


58. Puerperal Fever in Doncaster. 

By Robert Storrs, Esq. - - 224 

59. Management of Cases of Pro- 
lapsus of the Funis. By Prof. 
Osiander. - - - - 228 

60. Extraordinary Case of Twins. 

By Dr. Jamieson. - - - 229 

61. Short Funis. By Dr. J. B. 
Thomson. - _ . . 229 

62. Ante-version of the Uterus, re- 
duced by position alone. By Dr. 
Godefroy. - - - - 229 

63. Stony Placenta. By Madame 
Buisson Dauthez. - - 230 



Medical Jurisprudence and Toxicology. 


64. Marriage of the Deaf and 
Dumb. 231 

65. Poisoning by Muriatic Acid. 

By Mr. Herrship. - - - 231 

66. Aspyxia. By Dr. Richardson. 231 

67. Action of Chlorides upon Pro- 
tochloride of Mercury (Calomel.) 

By M. Mialhe. - - - 233 

68. On Pulmonary Emphysema, as 

a cause of death. By Dr. Prus. 234 

69. On Pulmonary Emphysema as 
an Anatomical proof of death by 
Asphyxia. By Alph. Devergie. 236 

70. Death by Strangulation, and an 


attempt to conceal the crime by 
burning the body. - - 236 

71. Presumption of Survivorship. 
By Dr. Krigelstein. - - 238 

72. Detection of Lead in the Mus- 
cles paralysed by it. By Dr. 
William Budd. - - - 240 

73. Hydrated Proto-sulphuret of 
Iron, an Antidote to Corrosive 
Sublimate. By M. Mialthe. - 241 

74. Cases of Asphyxia produced 
by the Light Gas of Strasbourg. 
By Professor Tourdes. - - 241 

75. Researches on the specific 
odour of the blood, - -242 


Case of Salaam Convulsion. By 
S. A. Barton, M. D. 

Notice of a Malignant Epidemic 
which prevailed in the Lying-in 
Department of the Philadelphia 
Hospital (Blockley) in March 
and April, 1842. By M. W. 
Wilson, M. D. - - - 

Cases of Closure of the Vagina in 
Infants after birth. By J. C. 
Nott, M. D. M. - - - 

Cimicifuga and Iodine in Incipi- 
ent Phthisis. By Dr. F. J. 

Medical Notes. By George Col- 
mer. - . . - - 

Intense Smarting of the Skin 
caused by the endermic use of 
Iodine. - _ - . 

Case of Neuralgia. - . - 

Child born with Small-pox erup- 

tion, the mother not having had 

- 243' the disease. By Dr. B. F. Jos- 
lin. 249 

Weight of New-born Children. 
By Dr. Storer. - - - 250 

Humerus fractured by a musket- 
ball — artificial joint. By Dr. 
244 W. L. Sutton. - - - 250 

Malignant Diseases of the Uterus. 

By Dr. Bigelow. - - - 250 

246 Fracture of the Scaphoid cavity of 

the radius— fracture of the lower 

end of the ulna. By Dr. W. 

- 247 Sutton. - - - - - 251 
Pereira's Materia Medica. - 252 

248 The Medical Student's Guide. By 
I Dr. Heber Chase. - - - 252 
[Dr. Bolton's Treatise on Strabis- 

248| mus. 252 

248 Necrology. , - - - 252 





JANUARY, 1843. 

Art. I. — Report of Surgical Cases treated at the Pennsylvania Hospital, 
By Geo. W. Norris, M. D., one of the Surgeons. 

Non-malignant Mammary Tumour of four years^ standing — Extirpa- 
tion — Cure. — Ellen Curtis, aetat. 23, unmarried, from Gloucester county, 
New Jersey, was admitted February 17th, on account of a large tumour of 
the right breast. She states, that some time in the winter of 1838, she first per- 
ceived a small, movable tumour, situated apparently just below the skin, and 
on the inner side of the right mamma. This gave but little uneasiness, till 
it increased to the size of a walnut, when she received a kick on the part 
from a cow, after which it was at times slightly painful. She now covered 
it with a simple plaster, which treatment was continued till the month of 
May 1841, when she fell into the hands of a quack, who applied a caustic 
plaster to the part, and, in the course of a short period of time, pushed a 
lancet into the tumour one hundred and twelve difi'erent times. Excepting 
blood, no discharge followed these punctures. The application of the caustic 
plaster produced sloughing of the skin, which on separating, left an ulcerated 
surface that has continued up to the present period. After this treatment the 
tumour slightly enlarged, and has since that time presented a more angry 
and inflamed appearance. Five weeks since, owing to a large venous trunk 
having been opened by extension of the ulceration, hemorrhage to a very 
large amount took place, which was arrested upon the occurrence of syncope; 
and on the evening previous to her admission into the hospital, a second 
bleeding to the extent of three pints had occurred, from the same cause, 
which was arrested by pressure. 

The tumour is now of large size, is very heavy, and is observed to be 
strongly lobulated, deep depressions existing between the lobes. These 
lobes are hard and inelastic, and the whole tumour is loose and free from 
No. IX.— January, 1843. 2 

14 Norris's Report of Surgical Cases in Pennsylvania Hospital. [Jan. 

any attachment to the parts beneath. About one-fourth of the skin covering 
the breast is ulcerated, the parts below presenting the appearance of a healthy 
indolent ulcer, discharging laudable pus, and with nothing like a fungous 
growth protruding from it. No hemorrhage has ever occurred from the sur- 
face of the ulcer. The skin is reddened around the ulcerated part, but is 
at no point puckered, and the veins on the upper surface of the breast pass- 
ing towards the neck, are very much enlarged. The nipple is observable, 
below the ulceration, healthy in structure, though nearly obliterated; at no 
time has there been any discharge from it. The tumour is not tender to the 
touch, neither is it painful, except on the approach, and during the continuance 
of the menstrual discharge; and with the exception of its weight and size, 
the patient, until within a short time, has experienced no inconvenience from 
it, and up to within two weeks of her admission into the hospital, had been 
actively employed in the domestic duties of a farmer's family. The left 
breast is of normal size and appearance. Her general health is good, and 
there is no enlargement of the cervical glands, or of those in the axilla. 
She is not emaciated, and her skin is free from sallowness, though her ap- 
pearance is that of a person debilitated from large losses of blood. Her 
menstrual periods, which on the first appearance of the swelling were irre- 
gular, both as to quantity and time, are now natural, and with the exception 
of some enlargement of the tonsils, she presents no mark of a scrofulous 

Upon the first aspect of this case, it presented the appearance of, and 
might upon a superficial examination have been pronounced, a tumour of a 
malignant kind; but the history of its rise and progress, as well as a careful 
examination of it, readily showed its true nature. The age of the patient, 
the want of sallowness in her skin, her comparatively good general health, 
and the slight pain she had suffered from it, were alone sufficient to lead us 
to suspect its freedom from malignancy; and when taken in connection with 
the great weight of the tumour, its loose attachment to the surrounding parts, 
the slow progress and duration of the disease, the absence of glandular dis- 
ease in its vicinity, together with the want of all fungous growth, and the 
discharge of laudable pus from its ulcerated surface, and its marked lobu- 
lated feel and appearance, proved conclusively that the character of this case 
had nothing in common with either cancer or fungus haematodes. The dis- 
ease was looked upon as belonging to that class denominated chronic mam- 
mary tumours, and in the advanced stage in which it existed, was evidently 
a proper case for the knife. It differed, however, from most tumours of this 
class in its great size, and a correct diagnosis of it was particularly important, 
as we could confidendy predict for the sufferer freedom from any return after 
the operation. 

In consequence of the occurrence of her menstrual period a day or tw 
after her admission into the hospital, the disease was not extirpated till 
2d of March. The operation was done in the usua. manner, the tumouf 

1843.] Norris's Report of Surgical Cases in Pennsylvania Hospital. 15 

being included in two elliptical incisions. The hemorrhage following it 
was not great, a point of suture was inserted in the middle of the wound, 
and its sides, in addition, were brought together with two or three strips of 
adhesive plaster, after which the wound was covered with a little lint, and 
the arm supported by a sUng. 

Upon examination after removal, the tumour was found to be made up of 
a number of separate lobes, very closely connected together by cellular tis- 
sue. The structure of these lobes was very dense, and when divided pre- 
sented very much the appearance of sweetbread. No vessels could be traced 
running through the tumour, which was completely surrounded by a cover- 
ing of thick tendinous substance. 

After the operation, she suffered from repeated attacks of erysipelas, as 
well around the wound as on the back, abdomen, legs, arms and face. These 
were treated by a careful use of the blue pill and mild cathartics, together 
with neutral or effervescing mixtures; the parts affected being bathed with 
soap liniment, and in consequence of her great debility, tonics and nourish- 
ing food of an unstimulating kind, in such forms and quantities as her exces- 
sively irritable stomach would allow her to retain, were administered. The 
applications to the wound, after the first day or two, were principally the 
common mucilaginous or water dressing, an adhesive strap being at the same 
time applied to favour cicatrization. 

On the 25th of March, a large abscess seated over the lower part of the 
back, was opened. On the 31st, abscesses which had formed on both upper 
extremities above the elbows, were opened. By the 2d of April, the wound 
was completely cicatrised. On the 12th and 23d of April, other large col- 
lections of matter resulting as in the former instances, from erysipelas, were 
laid open, and on the 5th of May she left the hospital for Jersey, in good 

Compound dislocation of the first, upon the second phalanx of the 
Thumb — Reduction impossible — Resection of the head of the first pha- 
lanx — Czo'C— -Neill Larkin, a stout drayman, aetat. 28, while engaged in 
unhitching his horse, had the end of his left thumb accidentally entangled in 
a link of the drawing chain, when the horse starting suddenly, dragged him 
some distance, and produced the accident just mentioned. He was brought 
to the hospital late in the evening of February 17th, a couple of hours after 
its occurrence, when strong and well-directed efforts were unsuccessfully 
made to reduce it, the clove hitch being attached to the extremity, after a first 
failure with the hand alone. On the following morning, I found the head of 
the first phalanx protruding considerably inwards through a wound which 
embraced more than one-half of the circumference of the finger; another 
effort at reduction was now attempted by bending the luxated phalanx and en- 
deavouring to push its projecting head over that of the adjoining bone, but 
failing in this, I determined to remove the protruding extremity of the bone, 

16 Norris's Report of Surgical Cases in Pennsylvania Hospital. [Jan. 

which was at once done with the metacarpal saw, to the extent of three or 
four lines, after which the parts were easily replaced. The edges "of the 
wound were then drawn together with strips of narrow adhesive plaster 
and the part covered with dry lint, the hand and fore-arm being secured upon 
a splint. After the third day, the dressings were daily made, the part being 
only covered with simple ointment. No unpleasant symptoms followed. 

March 23d. Wound entirely closed; on the 26th he was discharged, 
and on the 13th of April he called at the hospital, at which time he had 
good use of the thumb with some motion at the point of injury. 

The difficulty of reduction in cases of simple luxations of the phalangeal 
articulations, even when the patient is seen soon after the accident has occur- 
red, is well known, and the same difficulty exists in reducing and retaining 
in place compound injuries of this class. So hard is the reduction to effect, 
that it is asserted upon the authority of Bromlield, that the extending force 
has been increased to such a degree as to tear off the second joint in efforts 
to reduce the first. In compound luxations of the thumb, when found irre- 
ducible upon the application of a moderate degree of force, I believe the 
best practice to be that which was pursued in Larkin's case, viz., to saw off 
the end of the projecting bone. If the wound be large, and this be not done, 
observation shows that even when the part can be reduced, the dislocated end 
will in the majority of cases become displaced, as the inflammation neces- 
sarily following it, prevents the application of a sufficient degree of force 
by bandages and splints, to retain it in its natural position. One case of this 
kind I have myself witnessed, and another instance which occurred in Guy's 
Hospital has recently been published, in which, although the phalanx was easily 
reduced immediately after the accident, so much inflammation and constitu- 
tional disturbance occurred, as to make it necessary to remove the splints 
and other dressings which had been applied, and resort to cataplasms; the 
patient being ultimately cured, after entire loss of the first, and exfoliation 
of the extremity of the second phalanx. Resection of the phalangeal ex- 
tremity is the practice recommended by Sir A. Cooper, in compound dislo- 
cations of these parts, where difficulty is experienced in their reduction, and 
has often been done with good success. Gooch states that he sawed off the 
head of the second bone of the thumb, and that a new joint afterwards form- 
ed. In two instances, where the head of the metacarpal bone of the thumb 
was dislocated towards the palm accompanied with wound, and reduction 
was difficult, the protruding parts were successfully sawn off by Mr. Evans. 
Bobe, Wardrop, and Roux have all been successful in like cases. The bad 
effects resulting from these injuries where the head of the bone is replaced, 
and which seem to be at least in part owing to the force necessarily made 
use of, and the state of tension afterw^ards kept up in the surrounding soft 
parts, by its return, has been often noticed. An instance came under my 
care, in which high inflammation and tetanus ensued upon the injury, where 
this practice was pursued; and Mr. S. Cooper reduced a case at the North 

1843.] Norris's Report of Surgical Cases in Pennsylvania Hospital. 17 

London Hospital, which was followed by severe inflammation, terminating 
in death, a week after the accident, 

tdneurism by anastomosis — Ligature — Cure. — A female child, aetat. 
three months, was brought to the hospital on the 14th of February, with an 
aneurism by anastomosis of moderate size, seated a litde in front of the an- 
terior fontanelle. The mother stated, that at birth it was but just visible, 
that its growth latterly had been rapid, and that it was daily increasing. Two 
needles were passed transversely beneath the base of the tumour, taking 
care that they should enter, and pass out a little distance beyond the dis- 
eased structure, after which a ligature was drawn around its base sufficiently 
tight to strangulate it. Two days afterwards the pins were removed, and a 
poultice of slippery elm applied to hasten the separation of the slough. 
This came av/ay on the following day, leaving a healthy ulcerated surface, 
which in a short time was completely cicatrised. 

The mode of procedure adopted in the above case of transfixing the tumour 
by means of needles passed beneath it, at right angles with each other, and 
securing a ligature tightly around its base, is that which I usually employ, 
and is well adapted for the removal of all tumours of this kind of moderate 
size; the operation being safe, and quickly performed, and the pain caused 
by it but of short duration. The double ligature passed through tlie base of 
the tumour, which is often employed, may be followed by some hemorrhage 
after the tightening of it from the separation of the surfaces through which 
the needle is passed, besides which the shape or situation of the naevus may 
be such as to make it very difficult to fasten the ligature on either side around 
its base, entirely beyond the limits of the affection. A single needle placed 
under the centre of the tumour is also generally insufficient to procure the 
enclosure of all the diseased part within the loop of the ligature. 

Varicose Ulcer — Davat^s operation — Severe inHammation — Cure. — 
Thomas McCullen, a remarkably stout and healthy man, setat. 28, was ad- 
mitted September 21st, 1840, for ulcer on the inner and lower side of the 
right leg with great enlargement of the veins about the ankle. On the 26th 
two needles were passed through the vein a little below the knee, and a liga- 
ture twisted around them after the manner of Davat. No pain was com- 
plained of, or inflammation observed, for the first iew days after the opera- 
tion. On the 1st of October some redness was perceptible around the 
needles, and they were removed. On the 2d, the leg was swollen, hot, and 
painful, and on the day following, the man had fever, with pain extending 
up into the groin, the glands of which were much swollen. The tongue 
was furred, and the skin and conjunctiva of a yellowish hue. Small doses 
of calomel with neutral mixture, containing a small portion of tartarised anti- 
mony, and morphia in the evening, constituted the general treatment, while 
the local consisted in the application of leeches, followed by cold lead-water 

18 Norris's Report of Surgical Cases in Pennsylvania Hospital, [Jan. 

to the groin and thigh, with a poultice to the leg, which was laid in an easy- 
position upon a pillow. The symptoms continued unabated on the 4th, 5th, 
and 6lh, during which the same treatment was pursued with the addition of 
a purge. On the 7lh, his fever was less, and pain diminished. On the 8th, 
an abscess which had formed around the place of insertion of the needles 
was opened, and a large quantity of pus discharged from it. From this date 
he continued slowly to improve; the abscess, however, was long in filling up, 
and it was not until the 5th of December, that he left the hospital. 

The number of patients applying for admission into our hospital, afflicted 
with varix, is considerable, and in them, as well as in private practice, I have 
uniformly dissuaded from all operations for their cure, so long as relief could 
be aff'orded by the laced stocking or bandage. In cases, however, where 
the patient was greatly incommoded by them, or urgently demanded it, I 
have occasionally operated — generally, by the method of Davat, and never, 
until in the instance of McCullen, have seen any severe symptoms produced 
by it. Death, however, is reporled to have followed its employment, by 
Velpeau, S. Cooper, and others, and the severity of the symptoms in the 
above case, has induced me to report it, inasmuch as the operation is often 
done, and is looked upon, as indeed it generally seems to be, in no wise a 
dangerous one. 

Fractured thigh of twenty -one days^ standing — Union delayed by motion 
at sea — Firm union thirty -eight days after the application of DesauWs appa- 
ratus — Re-fracture during convalescence — Renewal of the treatment — Cure, 
— Joseph Pool, aetat. 45, a healthy seaman of good habits, entered February 
17th, with a fracture of the thigh near its middle part, which had occurred 
at Porto Rico, twenty-one days previously. The accident had been produced 
by a hogshead of sugar rolling over upon his limb, and had been properly 
dressed by a surgeon soon after its occurrence. A day or two after his in- 
jury, the vessel to which he belonged sailed for this port, and from that time 
the treatment of the limb was superintended by the captain, the extremity 
being placed in a long fracture-box, extending to the groin, and the foot 
fastened by means of a handkerchief to a cross-piece at its bottom, the frac- 
tured part being at the same time supported on its sides by pasteboard splints 
and thick pieces of sail cloth. 

Upon admission, the limb was found to be free from swelling or excoria- 
tion. No provisional callus appeared to have been thrown out around the 
fractured fragments, which admitted of much motion. The upper fragment 
was drawn outwards, and the lower was thrown inwards and a little up- 
wards, the limb being about one inch shorter than that of the opposite side. 
In order to place the fragments in good position, and make moderate pres- 
sure over the thigli, Desault's apparatus was applied to the limb, though but 
little extension and counter-extension was made, and a full diet with porter, 
was directed. 

1843.] N orris's Report of Surgical Cases in Pennsylvania Hospital, 1 9 

March I4:th. A considerable mass of callus has been thrown out about the 
fracture, but there is still some motion; to-day, pressure with pasteboard splints, 
moulded to the limb by previously wetting them, and firmly applied by means 
of a roller, commencing at the foot, was made use of, the long splints being 

26/A. Union perfectly firm. Desault's apparatus was removed so as to 
allow the patient to move his limb about the bed, the pasteboard being con- 

On the night of the 28th he re-fractured his limb at the point of previous 
injury, by turning over in bed during sleep, and entangling his foot in the 
sheet, in consequence of which the long splints were again employed. By 
the 17th of April the limb was found to be again firmly consolidated, when 
the apparatus was removed, and on the 7th of May he left the house with a 
good limb, and very slightly shortened. 

Another case of fractured leg of some standing, which had occurred and 
been treated at sea, was under care and discharged during my term. The 
patient, astat. 28, met with his accident on the 7th of November, by a blow 
from a chain cable. Both bones were fractured near the middle of the leg. 
He stated, that ten days after his accident, ulceration over the injured part 
occurred, after which the bone protruded. On the 29th of November he 
arrived here, and was brought to the hospital, at which time the extremity 
of the upper fragment was protruding, and was removed with the nippers by 
my colleague. Dr. Peace, the limb being afterwards placed and retained in 
a good position in a fracture-box. About the middle of January, a small 
piece of bone came away, when the wound soon cicatrised, and on the 28th 
of March he was discharged cured, union having been firm for some time 

A third case of delayed consolidation after fracture of the leg, treated 
at sea, occurred in the person of a sailor aged 22, who was admitted on the 
23d of March. His fracture was in the lower third of the limb, and had 
happened twenty-three days previous to admission, from a blow upon the 
part. The bones were quite loose when admitted, and some projection of 
the upper fragment was present. The limb was placed, properly supported, 
in a good position in a fracture-box, and a generous diet allowed. Pressure 
by means of pasteboard splints and a roller were after a short time applied, 
and by the 14th of April union was complete, and a large amount of callus 
surrounding the injured bones. The limb was now removed from the box, 
and on the 5th of May he left the house cured. 

The above cases are all well adapted to show the effect of motion in re- 
tarding the union of fractured bones, and the benefit derived from pressure 
and rest in their cure — a treatment which, as we have shown in a former 
number of this journal, is peculiarly adapted to, and likely to prove suc- 
cessful in, all cases of non-union, in which the cause can be attributed to 
motion, or want of proper position after the recent fracture, where the ends 

20 Norris's Report of Surgical Cases in Pennsylvania Hospital. [Jan. 

of the bone are not absorbed, and are connected by fibro-cartilaginous sub- 
stance, into which sufficient bone has not been deposited, or to cases where 
no sort of union has taken place, in consequence of previous want of perfect 
apposition, provided the ends can be brought into contact, and they have 
existed but for a short time. The case of Pool, too, is interesting on account 
of re-fracture of the bone during convalescence, and adds another to the 
many already recorded, going to show the ease with which the union of re- 
cently consolidated bones may be ruptured at their previous point of injury, 
the little danger there is of consequent inflammation of any degree of seve- 
rity, and the rapidity with which these re-fractures become united — points 
all of practical interest, as bearing upon the question of the propriety of rup- 
turing recent badly consolidated fractures. 

Dislocation of tlie radius forwards upon the humerus, with ununited 
fracture of the ulna in its upper third, of eight months^ standing — Resec- 
tion of the extremities of the fractured bones — Failure. — Darby Nelson, 
aetat. 39, was admitted on the 6th of April, and gave the following history 
of his case. — About the middle of August, 1841, he met with his accident 
in the state of Indiana, by a horse falling and rolling over upon him, his 
arm being caught between the animal and the ground. The day after the 
injury, the luxation of the radius and fracture of the ulna were recognised 
by the practitioner called to attend him, who dressed the arm with two long 
splints, extending from the elbow to the ends of the fingers. The limb was 
retained in these splints for nearly three months, and when thrown aside, 
the fracture was found not to have united, and the luxation of the head of 
the radius was seen to be unreduced. Upon examination, the rounded head 
of the radius was felt on the anterior part of the humerus, just above the ex- 
ternal condyle, rolling under the finger when the hand was rotated. The 
fore-arm could not be brought to a right angle with the arm, and when this 
was attempted, the head of the luxated bone was felt to strike against the 
humerus. Neither complete pronation nor supination of the hand could be 
performed when the arm was securely held. The condyles presented their 
normal appearance. The ulna was fractured three and a half inches below 
its upper end, and the superior fragment was drawn inwards and forwards, 
while the inferior was pulled upwards beneath it. The extremities of the 
bone passed each other to the extent of an inch or more. A great deal of 
motion existed at the point of fracture, and the muscles of both the arm and 
fore-arm were much shrunken. He complained of no pain when the part 
was handled. He was able partially to flex the fore-arm, but in so doing 
suffered pain, apparently from the pressure made on the soft parts by both 
of the fractured extremities. My colleague, Dr. Peace, who saw him in 
consultation, agreed with me in thinking that any attempt to reduce the ra- 
dius would be futile, and as he was urgent for something to be done to give 
strength to the part, and the operation appeared to offer some chance of sue- 

] 843.] Norris's Report of Surgical Cases in Pennsylvania Hospital. 21 

cess, we recommended that an effort should be made to procure union of the 
fractured ulna by resection of its ends. Accordingly, on the 13th of April 
the extremities of the bone were laid bare, and as much of them removed by 
a small saw as to allow of their being brought into apposition. The limb 
was then dressed as in ordinary cases of compound fracture, the sides of the 
wound being approximated, and a state of rest secured by the application of 
a proper splint. 

On the 14th he complained of some pain in the arm, had a M'arm skin and 
a furred tongue. The bandage around the arm was loosened, and a purge 
and the effervescing mixture directed for him. 

On'the 15th he had high fever and erysipelas of the limb, which was 
placed in a carved splint, and had lead-water applied to it. His mixture was 
continued, with the addition of a portion of blue mass at bed-time. 

By the 23d the erysipelas had disappeared: the wound looked well, but 
suppurated largely. Some time after this he suffered from a second attack 
of erysipelas of the whole limb, which terminated in abscess half-way be- 
tween the elbow and shoulders. On the 6th of May he had a third attack 
of erysipelas. After the subsidence of this, his general health improved 
rapidly, though cicatrization of the wound progressed but slowly. As soon 
as the state of the extremity admitted of it, pressure was made use of, and 
during the whole treatment a state of perfect rest was ensured to the limb. 
The employment of pressure and rest was continued till towards the end of 
August, when, there being no probability of firm union occurring, they were 
discontinued. At this time it appeared, upon careful examination, as if the 
ends of the bone had been somewhat absorbed and rounded, and the frag- 
ments united by ligament. 

The existence of great malposition in the fractured fragments in the above 
case, induced us to make choice of the operation of resection. The 
attacks of erysipelas from which the patient suffered after its performance, 
together with the free suppuration to which they gave rise, I am inclined 
to look upon as the principal causes of our failure to procure union. As an 
example of a rather rare accident, viz. luxation forwards of the upper ex- 
tremity of the radius, the case is also interesting. This injury, even when 
uncomplicated, is often difficult to reduce, and when accompanied with a 
fracture of the ulna, its successful treatment would necessarily be greatly in- 

Fistula in Perineo following a Jail — Operation — Cure, — At the com- 
mencement of my term of duty for 1840, I found in the wards James 
M'Cracken, a stout labourer, aged 26, affected with fistula in perineo. He 
stated that in September, 1839, he was upset in a railroad car, and was so 
thrown as to strike the perineum with force against the edge of the car. A 
small wound resulted from this, through which the urine flowed, and has 
continued to pass ever since the date of his accident. The fistulous opening 

22 Norris's Report of Surgical Cases in Pennsylvania Hospital. [Jan 

was found to be situated about two inches anterior to the anus and a little to 
the left of the raphe; it was small, and the urethra was so much contracted 
as to permit of the introduction of even a fine probe from this opening into 
the bladder with difficulty. A sound could be passed from the penis to 
within about an inch of the fistulous opening, at which point it was arrested 
by a hard unyielding mass, into which the finest bougie could not be made 
to enter. The opening in the perineum was carefully dilated until a full 
sized instrument could be passed into the bladder from it, when the follow- 
ing operation was performed. 

The patient being placed and secured as in the operation for stone, a large 
staflT was introduced through the fistula into the bladder, and a straight sound 
was passed from the mouth of the urethra down to the obstructed part, and 
carefully held by assistants. An incision was then made, exposing the point 
of the sound, and laying open the corpus spongiosum down to the track of 
the urethra, and extending below to the staff which had been passed into the 
bladder from the fistulous orifice. The sound was now withdrawn, and a 
full sized gum elastic catheter was passed from the penis down through the 
opening which had been made, and its end was then slid along the groove 
of the staff from this point into the bladder without difficulty. The latter 
was now withdrawn, and the sides of the incision were brought together 
with five points of the interrupted suture. 

21s/. Has but litde pain; some swelling of the scrotum and parts about 
the wound. Cold mucilage to the parts. 

On the 22d, union appeared perfect, and two of the lower sutures were 

24/A. The catheter was found so clogged that it was necessary to remove 
it, and some difficulty was experienced in replacing it, in effecting which the 
adhesions were partially broken up. 

21 th. Wound looks well and is granulating. Some pressure on its sides 
is made by means of a compress and strip of adhesive plaster. The catheter 
becomes so clogged that it is necessary to change it every second day. 

The wound after this date continued slowly to contract and cicatrise, the 
granulations being occasionally touched with nitrate of silver. By the 27th 
of July it had become extremely small, and the constant use of the catheter 
was omitted. By the 8th of August the wound had entirely cicatrised, and 
he urinated well. He was retained in the house in the capacity of assistant, 
in order to test his cure, until the 4th of November, when he was discharged 

Several months after his discharge, M'Cracken was seen by the nurse of 
the ward, and reported that he continued perfectly well. 

The operation of incision for the cure of fistula in perineo, is but rarely 
demanded, as ordinarily these cases may be cured after all strictures have 
been overcome, and the urethra has been restored to its natural size, by the 
use of the catheter, by cauterisation with nit. argent., a heated wire, &c. 

1843.] Norris's Report of Surgical Cases in Pennsylvania Hospital. 23 

"Where, however, cases are rebellious to this treatment, or as in the above 
instance, are accompanied by such circumstances as to render the use of the 
catheter impossible, nothing remains but a resort to it. When determined 
upon, care should be taken to have the urethra posterior to the opening well 
dilated prior to its commencement, and an instrument should always be 
passed into the bladder from this point previous to making any incision. 
For want of this precaution, patients have often been kept upon the table 
for a long time while a painful search was making for the opening, and more 
than one operator has had the mortification of seeing his patient removed to 
his bed without having succeeded in passing the instrument into the bladder. 

Forearm torn off by machinery a little below the elboiu — integument 
entirely stripped from the arm — imputation at the shoulder joint — 
Cure. — Patrick Scanlin, aetat. 21, was admitted on the evening of June 27th. 
At 11, A. M. of that day his hand had been entangled in the machinery of a 
cotton mill, in Darby, and the right fore-arm completely torn off, a little below 
the elbow, as well as the whole of the integument covering the arm, leaving 
the muscles bare and lacerated. The skin coveriiig the back was also torn 
up to some extent, but not separated, and the whole side and chest were 
severely contused. But slight hemorrhage followed the accident, and at the 
time of his admission into the hospital he had a full and strong pulse, and 
was suffering severe pain in the lacerated parts. A full dose of laudanum 
was exhibited to him and amputation at the shoulder joint determined upon. 
This was at once done (the patient being seated on a chair) by a circular 
incision of the muscles, while com.pression on the subclavian artery was 
made by my colleague. Dr. Peace. The parts were exceedingly vascular, 
requiring the application of an unusual number of ligatures — but little blood, 
however, was lost during the operation, the axillary being at once secured, 
and the other vessels being but of small size. The integument had been 
torn off to such an extent that it was impossible to close entirely the wound. 
The sides, however, were drawn together with adhesive strips, and covered 
with charpie, and a bandage afterwards applied around the chest. For a few 
days after the operation he seemed much affected by the weather, which 
was excessively hot, and had fever with delirium. These, however, soon 
passed off and he improved rapidly. On the 22d day, the axillary ligature 
came away, and on the 5th of October he returned home in good health. 

Fore-arm torn off by machinery at its middle part — Fracture of the hume- 
rus of the same side — Amputation — Cure. — Hugh Bennet, astat. 37, entered 
March 25th, at 9 P. M. Three hours previously his left hand had been caught 
in the machinery of a woollen mill and the fore-arm completely torn off near 
its middle. The bones had been fractured just above the wrist, and the soft 
parts having been stripped from them, they were left bare and protruding 
from the ragged stump for four or five inches. The humerus of the same 

24 Norris's Report of Surgical Cases in Pennsylvania Hospital. [Jan. 

side was also fractured below the insertion of the deltoid, which, according 
to the statement of the patient occurred from muscular action alone, he 
having with great presence of mind, when he found himself caught by the 
machinery, placed his foot against a firm body in front of him, and made 
use of all his muscular force to draw the entangled limb from it — in his 
efforts to do which the humerus gave way. Great swelling existed at the 
elbow and at the point of fracture, and the arteries of the stump were seen 
hanging down below the surface, pulsating violently, but without giving 
out any blood, their ends being tightly twisted. But little blood had 
been lost. The ragged end of the stump was amputated by the circular 
operation, the fractured humerus being firmly supported by splints. The 
usual dressings were applied and the arm afterwards placed in two paste- 
board splints moulded so as to embrace it in two-thirds of its circumference. 
A large opiate had been administered previous to, and was repeated some 
time after the operation. With the exception of an attack of inflammation, 
which occurred around the elbow, no untoward symptom followed; this ter- 
minated in abscess, which was opened on the 4th of April. By the latter end 
of this month, the humerus had become firmly consolidated, and on the 19th 
of May he was discharged cured. 

Dislocation of the shoulder of four loeeks^ standing — Reduction.— ^ 
Micajah Dielks, eetat. 51, applied to me, January 18th, 1842, on account of a 
luxation of his right shoulder, which he had received twenty-nine da5'S 
previously by a fall from a waggon. The head of the bone was in the axilla, 
and the distinctive symptoms of the accident were all well marked. The 
patient was muscular, and had already submitted to an attempt at reduction 
in the state of New Jersey, five days previous to my seeing him. The 
head of the bone admitted of considerable motion. On the morning follow- 
ing his arrival in town, the pulleys were applied, the extension and counter- 
extension being made in the usual manner, the first above the elbow and the 
latter by a sheet in the axilla, together with a strap over the acromion pro- 
cess of the scapula; at the same time a solution of tartar emetic was admi- 
nistered at short intervals. After the extension had been kept up about 
thirty minutes, a towel was passed under the head of the bone with a view 
of raising the latter from the axilla, which being done at the same time that 
the extending force was suddenly discontinued, produced a return of it to 
the glenoid cavity. A clavicle apparatus was afterwards applied. The day 
following the reduction, he complained of a good deal of soreness about the 
shoulder. The parts were well bathed with warm soap-liniment, and on 
the 25th he returned home — the stiflTness gradually disappearing. 

Dislocated shoulder of seven weeks^ standing — Reduction folloioed by in- 
flammation and suppuration about the joint — Cure. — Samuel Ickus, a stout 
countryman, setat. 25, from Carlisle, consulted me in December, 1840, on 

1843.] Norris's Report of Surgical Cases in Pennsylvania Hospital, 25 

account of a downward luxation of the head of the right humerus received 
forty-eight days previously. The symptoms of the injury were well mark- 
ed, and on the 21st the pulleys were applied. The extension was made 
gradually and moderately, for fifty-five minutes, previous to and during 
which time a solution of tartar emetic was freely given, and a large bleeding 
resorted to. At the end of the period mentioned, the head of the bone was 
returned to its socket, all deformity disappearing. Two days after the re- 
duction he was attacked with inflammation around the orifice made in the 
left arm by venesection, which went on to suppuration, and an incision for 
the evacuation of the pus was made on the 28th. The right shoulder, which 
had become hot and swelled soon after the reduction, despite the employ- 
ment of the usual means for allaying the inflammation, presented on the 30th 
more swelling, and an obscure sensation of deeply seated pus. On the 31st 
fluctuation was more distinct. A free opening was now made, and gave 
issue to a large quantity of well formed matter. After the opening of the 
abscess the discharge continued large till towards the middle of February, 
during which time he suflered from several attacks of erysipelas, whkh, at 
the time, was prevalent in the hospital. After this period, the discharge 
gradually lessened in quantity and became more serous. Early in March, 
an abscess formed at the posterior part of the axilla, which was opened and 
discharged freely. By the 7th of April the opening had closed, and all heat 
and swelling had left the part. On the 26th of the same month he left the 
hospital to return home, the head of the bone being evidently in the socket, 
though the parts about the shoulder were still much hardened and stiflf. 

Dislocation of the humerus into the axilla of ten zveeks^ standing — Un- 
successful efforts at reduction. — Daniel Collins, aetat. 50, was admitted 
June 1 1th, 1840, with a luxation of the humerus into the axilla of ten weeks' 
standing. He states that this accident was produced by a fall — that slight 
eflx>rts were made to replace the bone immediately after the accident by an 
unprofessional person, and that a week before his entrance into the hospital, 
well directed and long continued eflforts were made by a surgeon to reduce 
it. He was a blacksmith by trade, and, being anxious for a further trial to 
reduce it, had entered the hospital for this purpose. All the symptoms of 
luxation downwards were well marked — the head of the bone was drawn 
high up into the axilla and admitted of very little motion. The dangers to 
which he would be exposed by our eff'orts at reduction having been first 
plainly stated to him, the pulleys were applied on the 13th, and extension 
and counter-extension to as great a degree as was judged safe kept up for 
nearly an hour, at the same time that the muscular system was completely 
relaxed by the use of free bleeding and tartar emetic. At the expiration of 
this time, as the head of the bone appeared not to have yielded in any degree 
to the force employed, further eflforts were desisted from, and on the follow- 
ing day he requested his discharge. 

26 Norris's Report of Surgical Cases in Pennsylvania Hospital. [Jan. 

The subject of the reduction of dislocations of long standing is one of con- 
siderable interest to the surgeon. The class of cases and periods after the 
injury, in which attempts may be undertaken with any prospect of success, 
as well as the accidents that sometimes follow them, have not as yet received 
that attention which they merit. In the first of the above cases, the joint 
admitted of considerable motion, and the reduction at the end of one month 
was readily accomplished, and was not followed by more than the usual 
degree of soreness about the shoulder. In the second case, where the patient 
was young and robust, and the arm admitted of some motion, the reduction 
was accomplished nine weeks after the accident, by the employment of a 
less degree and shorter continuance of extensive force than I have repeatedly 
made use of, but was followed by inflammation and suppuration about the 
joint, 'j'his accident does not very often occur after the replacement of 
luxated bones, though cases have been observed in which it has succeeded 
the easy reduction of even very recent dislocations. In the last case, where 
the injury was of ten weeks duration, and the patient somewhat advanced 
in life, with the head of the bone drawn high into the axilla, we were foiled 
in our attempts to reduce it, and have understood that the patient afterwards 
submitted to a third pulling under the direction of a gentleman of this city, 
after previous division of some of the muscles or tendons about the joint, 
without better success. 

I am well aware that surgeons have always examined into the degree of 
motion existing in an unreduced joint before determining upon the propriety 
of an attempt at reduction in cases where bones have been long out, but 
nevertheless am disposed to think that we have been accustomed to direct 
our attention too much to the period which has elapsed since the receipt of 
the injury only, without allowing the situation of the bone and the degree of 
motion due weight in determining the question. Abundant evidence might 
be adduced to show that luxations have often been reduced after the limits 
fixed upon by our high authorities, where the head of the bone admits of 
slight movements, and is not drawn up closely into the axilla, and where an 
opposite state exists they are frequently irreducible long before that limit is 
arrived at. *' 

Compound fracture of the cranium rvith depression, unattended by 
symptoms of compressed brain — application of the trephine — Cure. — 
Benjamin Prime, setat. 18, was admitted, September 2nd, 1840. It was 
stated that early in the morning while asleep on board a vessel in the Dela- 
ware he had been struck over the head with an axe. Two small wounds 
were found to exist over the frontal bone a little to the left of the median 
line, rather more than two inches above the orbital ridge, which, on intro- 
ducing the finger, were found to communicate with a depressed fracture of 
the bone. No symptom of compressed brain existed. The pulse was 74; 
temperature of the skin good; pupils natural. A short time after his admis- 

1 843.] Norris's Report of Surgical Cases in Pennsylvania Hospital. 27 

sion, the depressed portion of bone was exposed by enlarging the wounds, 
and a small trephine was applied to the edge of the sound bone above the 
seat of fracture. Several small fragments of bone were removed, and the 
large part of the depressed portion, which was driven in for about half an 
inch, was then raised with the elevator. The coverings of the brain were 
uninjured. The soft parts were brought together with an adhesive strip and 
the wound covered with lint. Cold was applied to the head. Absolute diet. 
In the evening he was bled ^xvi. and the neutral mixture with a small por- 
tion of tartarised antimony was administered every two hours. 

3^. No pain or uneasiness in the head; pulse 80; tongue clean; wound 
not disturbed. A purgative was administered in the morning which pro- 
duced a free discharge from the bowels. In ihe evening he complained of 
some uneasiness in the head and was again bled §xiv. 

Ath. The wound looks well. The neutral mixture and antimonial were 
continued, and as his pulse was full and strong, blood was again taken from 
his arm. 

On the bill, he was free from pain or delirium, but presented a hot skin, 
with a pulse of 84. He was again bled, but after the loss of two or three 
ounces, became faint. A mercurial purge was ordered in the evening. The 
wound was suppurating kindly, and was dressed with lint wetted with 

\Uh. Since the last report the patient has continued to do well. A rigid 
diet, with antimonials, and simple cerate, or the water dressing to the wound 
having been continued, to-day he had slight epistaxis and complained of 
some pain in the head, to relieve which a vein was opened, but after a few 
ounces of blood were drawn, he fainted. 

On the 15^/i, he was free from headache, the wound presented a healthy 
appearance, though the cheek of one side was erysipelatous. The medicine 
he had been using was omitted, and the following directed: — B;. Antim. 
tartar, gr. i.; pulv. nit. potass, ^i.; aq. fluvial, ^vi. A table-spoonful three 
times a day. 

On the nth he was free from fever and all trace of erysipelas. On the 
19th and 20th, small pieces of bone were seen to be loose in the wound, 
and were removed, and his diet was cautiously increased. On the 27th an- 
other larger portion of bone, and consisting of both tables, was removed. 
After this date, the patient gradually recovered his strength, cicatrization of 
the wound, however, which was occasionally touched with nit. argent, and 
sulph. cupri., progressed slowly, and was not complete till the middle of 
November. On the 2nd of December he left the hospital in good health to 
return to his friends in Eastport, Maine. 

The following case, which occurred in my private practice, is not without 

Varicose aneurism at the bend of the arm — Ligature of the artery above 

28 Norris's Beport of Surgical Cases in Pennsylvania Hospital. [Jan. 

and below the sac — secondary hemorrhages with a return of the aneuris- 
mal thrill on the 10th day — Cure. — In May last, I saw in consultation with 
Dr. Rutter, Mr. K. aetat. 42, on account of a tumour at the bend of the arm, 
which had followed venesection. The patient, who had a permanent jaun- 
diced appearance, but was enjoying an apparently good state of health, gave 
the following account of it. In March he was bled at his own desire by a 
bleeder who had performed the same operation for him, and generally in the 
same arm, some thirty or forty times. Nothing extraordinary occurred, other 
than that he remarked the low of blood to be greater, and to be checked 
with more difficulty than had usually been the case. This was, however, 
done by firm compression, and on the day following finding the bandage 
tight, he removed it, and found the orifice to be completely closed. A short 
time after this, a small pulsating swelling was observed by him at this point, 
which slowly increased till a day or two previous to my seeing him, when, 
after some exertion with his arm, he observed a very considerable sudden 
augmentation in its size. Upon examination, a tumour of the size of a wal- 
nut was found at the bend of the arm; this was soft, pulsated strongly, and 
offered both to the touch and ear the purr and thrill peculiar to varicose 
aneurism. The vein running over the surface of the tumour, was greatly 
enlarged, and in its centre a cicatrix was perceptible, the skin around it ap- 
pearing to be exceedingly thin. By pressure the vein could be readily 
emptied, and when this was done, a pulsating tumour was plainly felt more 
deeply situated between it and the brachial artery, which, by firm pressure 
could likewise be made to disappear. Compression on the artery above the 
tumour stopped all pulsation in it, on the removal of which it quickly return- 
ed to its original size. The pulse at the wrist was weaker than that of the 
opposite arm. 

As the case was evidently one of false circumscribed aneurism, combined 
with aneurismal varix, and was increasing, I recommended him to undergo 
an operation for its cure, in which opinion Dr. J. R. Barton, who afterwards 
examined it, coincided. To this, however, the patient was averse, and I 
heard nothing more of him till the 16th of June, when I was again con- 
sulted, and found that he had been making use of strong and well applied 
pressure by means of a spring truss from the time I first saw him, and find- 
ing this painful and the tumour still augmenting, was now anxious to undergo 
the operation. 

This was done on the 17th. The artery being compressed in the arm, 
the skin was divided over the tumour in its whole extent, without however 
opening the vein. The sac and dilated vein were then fully exposed by dis- 
section as well as the artery, and ligatures were passed under the latter im- 
mediately above and below the sac. After careful examination to see that 
the ligatures surrounded the artery alone, these were secured — the lower 
one first. All pulsation in the part immediately ceased. The edges of the 

1843.] Norris's Report of Surgical Cases in Pennsylvania Hospital. 29 

wound were drawn into apposition by adhesive plaster, and the patient was 
put to bed with the limb extended on a pillow. 

On the 20th, pulsation could be felt in the radial artery. 

On the 27th a return of the thrill in the vein was detected. 

Early on the morning of the 29th he was awoke out of a sound sleep by 
hemorrhage from the arm, which, when I reached him, a half hour after its 
occurrence, had been checked by a professional gentleman in the neigh- 
bourhood by the application of a moderate degree of pressure; near a pint 
of florid blood was said to have been lost. Finding him easy, I left him with- 
out in any way disturbing the wound, but before mid-day was again sum- 
moned on account of a renewal of the bleeding. Upon removing the dress- 
ings, this was found to proceed from the opening through which the upper 
ligature passed. The parts around the wound presented a good appearance, 
no inflammation existing, and the divided parts having entirely united except 
at the points through which the ligatures passed, neither of which were yet 
loose. Accurate examination of the brachial artery showed the extremity of 
the vessel above the upper ligature to be hard, and completely filled with 
coagulum, and this, in connection with the return of the thrill in the vein, 
which was now nearly as strong as it had originally been, and the direction 
from which the blood seemed to flow, led both my friend Dr. E. Peace, 
who was present with me, and myself, to look upon the hemorrhage as 
proceeding from some opening in the upper part of the sac, and it w as de- 
termined to lay open the vein and sac, first passing ligatures under the vein 
above and below, and afterwards tie up any vessels which should be found 
to give out blood. This was at once done, and a vessel from wliich arte, 
rial blood w^as poured out was secured at the bottom of the sac. 

This proceeding was painful, but gave rise to no undue inflammation or 
fever. On the 3d of July, the ligature on the lower end of the artery (below 
the sac) was found to be loose and was removed. On the 7th, there was a 
return of the hemorrhage to the amount of several ounces, which was 
checked by lint and co r pression, and during the night other recurrences of 
bleeding took place which were each time restrained by pressure. On the 
8th there was a renewal of the bleeding to such an extent as to necessitate 
the application of the tourniquet. All dressings wers now^ removed prepara- 
tory tu s-c'.iring the artery high up in the arm, but the hemorrhage was 
found to have entirely ceased. It was now concluded to apply pure crea- 
sote freely to the wound, which was done by means of a camel's hair brush, 
and lint saturated with this substance was afterwards placed over the part 
without any other dressing, the extremity being extended on a pillow; the 
upper ligaiure was seen to be loose and was removed. On the 12th, the 
lint having become loosened by suppuration, was removed, and dry lint 
applied, which was changed every second day till the 25th, when cicatrisa- 
tion had taken place. 

In the beginning of the present month, (October,) I saw Mr. K,, and found 
No. IX.— January, 1843. 3 

30 Norris's Report of Surgical Cases in Pennsylvania Hospital. [Jan. 

no trace of pulsation or tumour at the bend of the arm — the extremity had 
regained all its former power. 

The preceding is an example of the affection first accurately described by 
Park and Physick, in which a false circumscribed aneurism exists in con- 
nection with aneurismal varix. The course of treatment to be pursued in 
either form of aneurismal varix, does not seem to be yet well determined by 
surgeons; some recommending simple ligature of the vessel above and below 
the sac without an opening into it, some the Hunterian method, some the 
ancient operation for aneurism, while others are inclined to rely upon com- 
pression alone. 

Despite the superficial situation of the vessel, but few examples of the 
cure of false aneurisms at the bend of the arm by the latter method, (com- 
pression,) can be cited, except it be made immediately after the occurrence 
of the accident, when, if applied with judgment, it will generally prove suc- 
cessful. The mere application of pressure over or above the wound, in the 
way it is commonly made after venesection, will, however, almost invariably 
fail. Where the artery is wounded and compression is resorted to, a folded 
piece of lint should be placed over the wound, and a roller well and evenly 
applied to the member from the fingers to the shoulder, which will prevent the 
oedema and great pain so often resulting from the application of pressure at 
the point of injury alone. The limb after the bandaging should be kept in 
a state of perfect rest by means of an angular splint applied on the side of 
the arm, for a week or ten days after the accident, during the whole of 
which time the patient should be closely watched, and the bandage renewed 
as often as may be necessary. 

Where, however, some time has elapsed after the production of the dis- 
ease, compression is little to be relied on in its results, severe pain, excoria- 
tion, and even gangrene of the sac, having all repeatedly occurred from its 
application. Except when very recent, too, the Hunterian method is now 
commonly looked upon as inapplicable in these cases, and is abandoned, 
general experience proving that it fails where the affection is of any stand- 
ing. The old operation of laying open the sac and securing the vessel above 
and below the wounded point, is still recommended by many estimable 
authors, is often performed, and I believe, when the disease is of long stand- 
ing, or of large size, is always the best and safest operation. In the case 
related, ligature of the vessel above and below the tumour, without meddling 
with its contents, was resorted to, inasmuch as the disease was only mode- 
rately developed, in order to avoid the increased danger attendant upon inci- 
sion of the sac. The accidents to which the method exposes are well ex- 
emplified by the above case, and were such as will prevent my ever again 
having recourse to it, in other than the cases specified. In all the opera- 
tions for varicose aneurism it is better, if possible, to avoid division of the 
vein; sometimes, however, this is impossible, and where divided, a thin 
ligature should be applied to it. 

1843.] Hildreth's Observations on Chorea, 31 

Art. II. — Practical Observations on Chorea. By Charles C. Hildreth, 
M. D., of Zanesville, Ohio. 

Case I. — Miss H., aetat. 12, residing in Zanesville, had for many years 
been troubled with some of the symptoms of chorea; her excessive 
muscular action, however, was attributed by her family to exuberant 
animal spirits, and other causes. For the greater part of her life she has 
been pale and exsanguine in appearance. Her mind has been severely 
taxed in the acquisition of kno\\ ledge, while her muscular system has not 
been sufficiently developed by active exercise. 

The character of her disease having become distinctly manifest, I was 
requested to prescribe for her, October 8th, 1841. Suspecting, from her 
general appearance, the presence of unhealthy secretions in her abdominal 
viscera, she was in the first place put upon an alterative cathartic course of 
blue mass, compound extract of colocynth, and rhubarb. This course was 
continued for the first week of my attendance, maintaining a gentle action of 
the bowels daily. Her evacuatrons were, in the first place, found to be dark 
and unhealthy, but in a few days assumed a natural appearance. As she had 
been the subject of an eruptive disease (probably urticaria), which was now 
suppressed, the tartar emetic eruption was brought out pretty freely over her 
stomach and bowels, and also over her spine. 

In the beginning of the second week of my attendance (during which time 
her disease became daily aggravated), I began the tonic course so evidently 
indicated by her external appearance. She was directed a drachm of the 
precipitated carbonate of iron in port wine, three times daily. Morning and 
evening she took a shower bath, which was followed by sponging the whole 
surface with a saturated solution of common salt in proof spirit, and vigo- 
rous friction with a coarse flannel cloth. She was also directed a wine-glass 
of the strong decoction of the cimicifuga racemosa, to. which some spices 
and a little brandy had been added. This was ordered three times daily, 
but on account of its nauseous taste, was seldom taken in the proper dose. 
A liberal diet of animal food was allowed, and as much exercise as possible 
in the open air. Involuntary muscular action began to diminish percepti- 
bly in a few days after we commenced the tonic and invigorating treatment. 

In the third week of my attendance, there was a marked improvement in 
her general health, strength, and appearance. The natural colour was re- 
stored to the lip, cheek, and tongue, which, when I first saw her, were in 
aspect nearly bloodless; appetite good, and flesh and strength returning. 

In the latter part of the fourth week, as her recovery was not progressing 
as rapidly as I could have wished, the prepared carbonate of iron was sus- 
pended, and the sulphate of quinine given in full doses. This was directed 
in the dose of five grains, three times daily, in conjunction with the black 

32 Hildrelh's Observations on Chorea. [Jan.- 

snakeroot. When one drachm had been taken in this way, it was quite 
apparent that she was improving much faster than while using the iron. As 
no bad effect was perceived from the medicine, no disturbance of head or 
stomach, the dose was increased to 20 grains per diem. This produced 
some tinnitus aurium, with increased fuhiess and force of the arterial circu- 
lation, and was not exceeded. In three days after this dose was given, 
involuntary muscular action had ceased entirely, nor has she had any symp- 
toms of a return of her disease up to the present date — June 15th, 1842. 

Case II. — Jan. 9th, 1842. Was requested to prescribe for a little girl of 
Mr. M., tetat. 11, residing in Zanesville. The symptoms of chorea were 
well marked, and the same general plan of treatment was adopted — altera- 
tive cathartics, until the secretions became healthy; the shower-bath and 
stimulating frictions, warm clothing, liberal diet, and full doses of the iron 
and cimicifuga. This patient was also in an anaemic condition, and her dis- 
ease increased upon her until the tonic course was commenced, when there 
was an immediate improvement in the symptoms. The chalybeate and other 
treatment was continued until there was a restoration of the colouring matter 
to the blood, and a decided improvement in strength; the quinine was then 
substituted for the iron, in the dose of five grains three times daily. This 
dose produced considerable tinnitus, and was not exceeded. The improve- 
ment in this case was equally marked and rapid as in the last. The quinine 
exerted a marked controlling influence over the disease, and in four or five 
days from its first exhibition, entirely restored the patient. 

Case III. Partial Chorea, followed by Paralysis. — Mrs. J. Y****, eetat. 
18, of nervous temperament, and but four months married, began to men- 
struate when 17 years of age. This uterine function was but imperfecdy per- 
formed, and attended with much pain. She has menstruated but twice since 
puberty, but has periodical monthly attacks of pain in her back and groins. 

Was called to prescribe for her in an attack of pleurodynia, April 25th, 
1842. This disease did not yield readily to the ordinary treatment, but left 
her spontaneously at the regular recurrence of the monthly period, when the 
pain was transferred to the lumbar spine. 

The use of anodynes in liberal doses, in conjunction with counter-irrita- 
tion, diminished the severity of the pain, but did not entirely relieve it until 
the expiration of the usual period of menstruation. 

A vaginal examination developed nothing abnormal in the state of the 
uterus or vagina; no enlargement of the cervix, or body of the organ, nor 
accumulation within its cavity, or occlusion of its external orifice. Her 
amenorrhcsa is probably the result of deficient constitutional vigour, as is 
indicated by her anaemic or chlorotic appearance, and will yield to the proper 
tonic and alterative treatment. 

Two days after the disappearance of the uterine pain, she took intermit- 

1843.] Hildreth's Observations on Chorea. 33 

tent fever, to which she had been subject some six months previous. The pa- 
roxysm was quotidian and violent in character, the rigor of long continuance, 
the fever intense, and the perspiration profuse. Symptoms of chorea about the 
same time began to appear; when recumbent, they were scarce perceptible, 
but when sitting or standing, very obvious. The head was in constant motion 
when off the pillow; rapid flexion and extension; this was continued for 
hours, and entirely involuntarily, but ceased immediately the recumbent pos- 
ture was resumed. When standing, the lower extremities were found but 
slightly under the control of the will; she could not walk without assist- 
ance, and but with great uncertainty of motion. Upon examination, the 
upper cervical and entire lumbar divisions of the spine were found very ten- 
der on pressure; the dorsal but slightly afl'ected. 

The treatment was commenced by the application of strips of blister to 
the sensitive portions of the spine, and with an obvious influence over the 
muscular action. When the blisters had nearly healed, a copious eruption 
of tartar emetic pustules was brought out over the same surfaces. The inter- 
mittent was in the mean time treated by large doses of quinine; twenty 
grains were given at one dose, four hours before the expected paroxysm. 
The first dose arrested it, but the remedy was continued to the amount of 
fifteen grains daily, for four or five days subsequently. The counter-irritation 
to the spine, in conjunction with the quinine, arrested all symptoms of chorea 
in the course of a week. 

When involuntary muscular action had in a great measure ceased, signs 
of paralysis of the right leg became manifest. These symptoms came on 
gradually, and were evidently of spinal origin. There was loss of sensation 
as well as muscular action in the leg. The introduction of pins or needles, 
pinching, &c., gave no pain. When supported upon her feet, she had very 
little control over its motion; temperature of the limb but very slightly 
affected. This partial paralysis passed off' in a few days under the influence 
of stimulating frictions to the leg, and increased amount of counter-irritation 
over the lumbar spine. 

May lOth. — Found the patient free from signs of chorea and paraly- 
sis, and regaining her strength rapidly under the use of the preparations of 
iron and other invigorating remedies. 

This case will justly be called partial chorea, having its origin undoubt- 
edly in spinal irritation. If, however, it had been left to nature, or if some 
depressing or exhausting cause had been superadded, it woidd no doubt in 
a short time have become general in character, and from its numerous com- 
plications might have proved troublesome in treatment. The strong con- 
nection among some of the neuroses is also here exemplified. 

The pain in the side is suddenly transferred to the uterus, and both are 
undoubtedly of a neuralgic character. The paralysis succeeds the chorea, 
and having each a spinal origin, yield to counter-irritation over the portions 

34 Hildreth's Observations on Chorea. [Jan. 

affected. The intermittent yields readily to quinine in liberal doses, which 
has also probably exercised a happy influence over the chorea. 

In this case there was no apparent connection between the spinal irritation 
and the intermittent. In other instances, however, it has been marked and 
obvious, and we have found it almost impossible permanently to arrest the 
ague, without first relieving the spinal affection. Some portion of the dorsal 
vertebrae, in such cases, has usually been found tender on pressure. 

I have in other cases of chorea given quinine with zinc, in the small doses 
directed in the books, but with no perceptible advantage. Having observed 
the prompt action of a twenty grain dose of quinine in arresting the paroxysm 
of an intermittent, or a regularly recurring neuralgia of any kind, I was led 
by analogy to its use in large doses in chorea, in which disease the nervous 
system appears chiefly to suffer. Judging merely from its action in those 
few cases in which I have given it, I believe it will very much shorten the 
duration of the disease. The dose should be sufficiently large to produce 
tinnitus aurium occasionally, but not constantly, as there might be danger 
of seriously impairing the hearing if this symptom were allowed to persist. 
From fifteen to thirty grains a day, according to the age and strength of the 
patient, will be the proper quantity. The proper case for its exhibition 
should be selected: thus it would not be prudent to give it without prepara- 
tion when there was evidence of cerebral determination or congestion, or 
fulness of the vascular system. The secretions from the stomach and bowels 
should first be rendered healthy, and if the patient be decidedly anaemic or 
chlorotic, the preparations of iron should precede or accompany it. 

During my residence in Zanesville, I have treated but eight cases of chorea, 
all of which have occurred in females, and all, except two, under the age of 
puberty. These cases have recovered in from three to six weeks after being 
subjected to treatment. The cimicifuga has in nearly every instance vbeen 
exhibited, and to it I believe I am chiefly indebted for the cure of a majority 
of the cases. I have found, however, no small diiHculty in persuading my 
younger patients to take the proper dose of the remedy, on account of its 
nauseous taste. The pulverised root has generally been directed in the dose 
of a tea-spoonful three times daily, in syrup, but in this manner I have not 
been able to give it for any length of time. I have found the saturated tinc- 
ture (of which one or two drachms is the proper dose), or the strong decoc- 
tion with spices, and a little brandy to prevent acidity, the better forms of 
exhibition. To insure its sanative influence, as large a dose should be taken 
as can be borne without inducing nausea or vomiting, or much disturbance of 
the cerebral organs. For this purpose it should be gradually increased until 
this result follows, in the same manner that we increase the dose of digitalis 
or colchicum, to which, indeed, it bears no small resemblance in narcotic 
properties, although of much less activity. The purgative plan advised by 
Hamilton and others, and which was adopted in some of my earlier cases, 

1843.] Hildreth's Observations on Chorea, 35 

I am now convinced very much retarded their recovery. Nor can I conceive 
the plan of long-continued purging adapted to any case, after the secretions 
become healthy, unless there be evidence of a state of plethora, or signs of 
cerebral determination or congestion. 

A directly opposite state has been found to exist in all the cases that have 
come under my observation. There has been a want of tone in the system, 
the powers of life have been depressed, the complexion pale and exsanguine, 
and every evidence of anaemia or chlorosis present. The secretions from 
the abdominal viscera have been but slightly deranged, requiring but few 
doses of alterative medicine to correct them. The tonic and invigorating 
treatment has invariably been beneficial, while any source of exhaustion or 
depletion has appeared to aggravate the disease. In my last case (Miss C, 
aetat. 18, residing five miles from Zanesville), the chorea appeared to be the 
direct result of severe antiphlogistic treatment, which had been adopted during 
an attack of y)luro-pneumonia. The frequent use of the lancet, and other 
remedies, left her in a very weak and exhausted condition, in which state the 
symptoms of chorea first manifested themselves. Her menses were sup- 
pressed at the same time, and apparently from the same cause. 

She was directed immediately a strong tonic and invigorating course of 
treatment. The precipitated carbonate of iron and cimicifuga, in full doses, 
counter-irritation to the spine, shower-bath, and stimulating frictions, warm 
clothing, exercise in the open air, &c. Her menses returned in the second 
week of the treatment. She made a tolerably quick recovery, but not until 
her flesh, strength, and complexion were in a great measure restored under 
the influence of tonics, liberal diet, &;c. 

That chorea is a disease quite amenable to treatment, may be inferred from 
the host of remedies offered for it by different authors. Of these the tonic 
occupy the first rank. Thus the preparations of iron, zinc, copper, silver, 
and arsenic,* have each their advocates; of the vegetable tonics, the cinchona 
and its preparations are most worthy of notice; of narcotics and antispas- 
modics, the cimicifuga, the belladonna, hyoscyamus, &c. claim attention. Of 
this class the cimicifuga is not only the safest, but by far the most effica- 
cious, in all probability. The same may be said of iron among the tonics. 
Dr. EUiotson's experience leads him to confide in it, without the previous use 
of purgatives. Should the dose of tlie precipitated carbonate be found ob- 
jectionable, the patient can perhaps be persuaded to take the proto-carbonate, 

* A medical friend of undoubted veracity informs me that lie once knew a case of 
chorea cured in four or five days by mistake. The patient was a mulatto girl of 17 years. 
Her physician had great confidence in the powers of arsenic in this affection. He there- 
fore prescribed ten drops of Fowler's solution three times daily. The patient, thinking 
this dose entirely too small to do any good, took twenty or thirty drops instead often. As 
a matter of course, she was completely poisoned in a very short time, and was obliged to 
take the proper antidotes for arsenic to save her life. On recovering-, however, from the 
effects of the poison, she was found to be permanently free from all signs of chorea. 

36 Watson on the Pathology and Treatment of Varices. [Jan. 

the lactate, or the iodide, the last of which will be found peculiarly applica- 
ble to chloroiic cases. 

Art. III. — ^n Inquiry into the Pathology and Treatment of Varices, By 
John Watson, M. D., one of tlie Surgeons to the New York Hospital. 

To determine the safest and most effectual mode of curing varices, is a 
question that of late has excited much attention. Prior to the experiments 
of Sir Everard Home by the application of a ligature to the veins, the 
pathology of these vessels had only begun to excite attention. Since that 
period the subject has be^n more thoroughly investigated, and has led to 
greater caution in interfering with the affections now under consideration. But 
notwithstanding the unfavourable results thnt have so frequently marked the 
various modes of treating varices, those most familiar with the sufferings, 
dangers, and sometimes fatal consequences attending these diseases when 
allowed to progress, still look upon the question of their treatment as one of 
absorbing interest. 

With a view to throw some further light upon this inquiry, it will be ray 
object in this paper to offer some remarks upon the pathology of varices: 
to review in a summary way the various modes of treatment hitherto em- 
ployed for the cure of them; and to give the details of the operative proce- 
dures to which I have myself resorted. 

I shall pursue the subject in the order in which it has grown upon me; 
namely, by the study of individual cases. 

Part First. — Cases and Comments. Case I. — Mr. M., a teacher, about 
30 years of age, came to the city from Orange county, to be cured of a 
troublesome varicose affection in his left leg, of several years duration; and 
of late so painful and annoying, as to prevent him from attending to his 
usual occupation. 

The disease involved the whole of the great saphena, but was most 
marked in the internal saphena and its principal branches, many of which 
were excessively dilated, contorted, and nodulated. 

The operation proposed by Dr. Stevens, v/ith whom I saw the patient, 
and which he performed May 27th, 1839, was the sub-cutaneous division 
of the saphena major, just below the middle of the thigh. The vessel was 
raised with the integ^uments covering it, and divided from beneath outward, 
without wounding the skin except at the point of puncture. A compress and 
roller were afterwards applied, and the patient was directed to keep the limb 
at rest in the horizontal position. 

June 3d. The dressings were removed for the first time. The wound 
had healed; there was still slight ecchymosis around it, but neither swelling 
nor inflammation. The varices, when the patient put his foot to the ground, 

1843.] Watson on the PatJwIogy and Treatment of Varices. 37 

instantly reappeared, and were as well marked as before the operation; 
although perhaps not quite so large. The course of the blood did not ap^ 
pear to be interrupted at the point of incision. The edges of the wound in 
the vessel had in all probability united by adhesion, without obstructing its 
calibre; as they almost invariably do after ordinary venesection. 

4th. The patient being anxious for more effectual relief, Dr. S. at my 
suggestion, performed the following operation: 

An incision about an inch and a half long was carried through the skin, in 
the course of the vein, a few inches above the knee. After thus exposing- 
the vessel it was raised on a probe and about half an inch of its calibre was 
excised. Free hemorrhage followed from both extremities of the cut. 
Slight pressure after a few moments put a permanent stop to the bleeding- 
from the upper part of the vessel; that from the lower part was arrested by 
the application of a ligature. The edges of the wound were then drawn 
together by adhesive straps, and a compress and roller were applied as on 
the former occasion. 

I3th. The ligature came away; the wound was suppurating slightly; the 
surrounding parts were free from inflammation. 

2Sd. The wound had cicatrised; the bandage was entirely removed. The 
varices appeared to be efl'aced, except at the inner and upper part of the leg, 
where the principal swellings had existed. The bandage was replaced, and 
the limb again put in the horizontal position. 

28/A. The patient returned to the country much relieved, but not entirely 
cured; the principal varix at the upper part of the leg being slill apparent, 
and the blood filling the vessel even up to the level of the cicatrix. 

I saw this patient several months after the operation. The varices had 
reappeared in all the branches of ihe internal saphena; but were less dis- 
tended than they had formerly been, and gave him less uneasiness. 

The first point established by this case is, — that the simple subcutaneous 
division of a varicose vein, is not a certain means of obstructing the passage 
of the blood through the vessel. This fact might, indeed, have been de- 
duced from the results of ordinary phlebotomy. Every practitioner is aware 
that the arms of his patients may be marked by numerous cicatrices, the re- 
sult of repeated venesection in the same vessel, and almost all at the same 
point, without diverting the current of the blood from its natural channel, or 
diminishing the calibre of the vein; although many of these lancet wounds 
may have been free in the division of integument, and of sufficient depth 
and extent to have completely divided the vessel; and all of them, as in this 
case, followed by compression. 

The second deduction, and one perhaps of more importance, is that the 
excision of a considerable portion of a varicose vein, although it efi'ectually 
interrupts the course of the blood at a given point, does not necessarily pro- 
duce an obliteration of the vessel, either above or below that point; and is 
not a certain means of curing varices, either in the vessel itself, or in any of 
its branches. 

Case 11. — Z. P. Esq., of Green county, N. Y., a gentleman about 56 
years of age, tall and of spare habit, but accustomed to vigorous exercise, 
came to the city for advice on account of extensive varices in all the superfi- 

38 Watson on the Pathology aad Treatment of Varices. [Jan. 

cial veins of his right leg. Having in a measure failed to effect a cure in the 
foregoing case, it was not thought advisable to repeat the operation; and as 
the starched bandage was much in vogue about this period, and had recently 
been tried in a few similar cases at the Bellevue Hospital, I took occasion to 
try it on this patient. The leg was accordingly encased with a moderate 
degree of tightness in the starched apparatus, and the patient was directed 
to walk about as usual, and to allow the bandages to remain upon the limb 
as long as they would retain their proper position, provided they gave him 
no uneasiness. 

I saw this gentleman about a year afterwards. He had worn the bandages 
about three months, during which time he had exercised much on foot, and 
had experienced much relief, and, as he said, comfort, in the use of the ap- 
paratus. But after its removal the varices were found to be as large and 
troublesome as ever. At this time he applied to me for advice on account 
of a pruriginous eruption with which he had been long affected, and which 
appeared to have some connection with the varices. 

From the trial of the starched bandage in this case, I was induced to be- 
lieve that, as a palliative measure, it possesses some advantages over the 
ordinary roller, as also over the military gaiter and laced stocking. When 
properly applied, the support rendered by this bandage is uniform; it is not 
readily disarranged, and may be worn without changing, for several weeks 

Case HI. — Thomas Fitz Herbert, of Ireland, wire-worker, aged 40, was 
brought into the New York Hospital, late on the evening of May 17th, 
1841, in a state of extreme exhaustion from loss of blood. He had long 
been subject to varicose veins, accompanied with an ulcer on one of his legs. 
While passing along Water street in the dark, he struck his diseased leg 
against a cellar door. The injury though slight in itself, gave rise to he- 
morrhage from one of the enlarged vessels; and before his friends had time 
to bring him to the Hospital, (no measures having previously been taken to 
arrest the discharge), he had lost so much blood as to be beyond the power 
of recovery. He died in a few minutes after admission. 

The result of this case is sufficient to prove that varicose veins of the 
lower extremity constitute something more serious than " a trifling inconve- 
nience;" and to justify the cautious and enlightened surgeon in further 
efforts to discover some certain mode of treating these affections, or to 
modify old modes in such a way as to render them more simple and effi- 

Case IV.— Mr. W., of Plainfield, N. J., hatter, aged ,35, had for several 
years been troubled with an ulcer on his right shin, and a varicose state of 
the veins of the leg. On the 27th of May, 1841, he called upon me for ad- 
vice. The integuments for some space around the sore were of a deep 
purplish hue almost black; the ulcer was small but irritable, and seated in 
the midst of an old cicatrix. The whole limb was somewhat swollen, and 
the external saphena, and its branches as low down as the foot, were en- 
larged, nodulated, tortuous, and painful to pressure: the internal saphena 
was unaffected. The varices were of tnore recent date than the ulcer, and 
appeared to have much influence in preventing it from healing. The disease 

1843.] Watson on the Pathology and Treatment of Varices. 39 

prevented the patient from pursuing his occupation, and he was anxious to 
submit to any treatment likely to afford him permanent relief. 

I directed simple dressings to the ulcer, a roller to the limb, with repose 
in a horizontal position; and if at the end of a month the ulcer still per- 
sisted, I suggested the propriety of an operation upon the veins. The pal- 
liative treatment was pursued for the time specified, with little or no other 
effect than a slight diminution in the size of the ulcer. On the 17th of June 
I was summoned to Plainfield to perform the operation. 

The patient being in a recumbent position, a fillet was applied around the 
lower part of the thigh for the purpose of rendering the vessels turgid. An 
incision about an inch and a half long was then made in the course of the 
external saphena, near the outer and lower edge of the popliteal space, with 
a small straight bistoury. After exposing the vein it was elevated on a i)robe, 
and thus left for the instant. A second incision was next made over a large 
branch of the same vessel, at an anastomosing point near the middle of the 
leg, and a probe inserted beneath the vein as at the first point. The same 
procedure was repeated on an enlarged vein just below the ulcer, above the 
ankle, at another point of anastomosis; and lastly, on a dilated vein upon 
the dorsum of the foot. 

After thus completing the first steps of the operation, the fillet was re- 
moved. And while pressure was applied by the fingers of an assistant in 
the course of the vein, both above and below the last incision, with a pair 
of forceps I raised the vessel from the bottom of the wound, and with a pair 
of scissors removed about half .an inch of its substance. No hemorrhage 
followed the excision of the vein. The same procedure was repeated on 
all the other portions of veins that had been exposed by the incisions, with- 
out giving rise to any bleeding. The ed<^es of the wounds were then drawn 
carefully together by adhesive straps, and each wound covered with a com- 
press. Finally, the whole limb was enveloped in a roller from the foot to 
the middle of the thigh. The patient was now directed to remain on hie 
back for at least a week, and for the first twenty-four hours to be kept 
under the influence of anodynes. On the day following the operation, the 
roller, giving him no uneasiness, was coated with paste; and another roller 
placed over it, and also pasted, so as to render the whole dressing firm, and 
to prevent it from wrinkling. 

The coats of the two uppermost pieces of vein that had been removed, 
were at least half a line in thickness. The inner tunic was of a pale flesh 
colour, and by the contraction of the vessel, thrown into longitudinal rugae, — 
giving it the appearance of muscular fibre. The middle coat, more hyper- 
trophied than the rest, was of a cartilaginous colour and consistence. The 
two lower pieces of vein, though dilated, were more nearly of a healthy 
structure; the inner lining, glossy and of its natural colour; the middle coat, 
sufliciendy hypertrophied to prevent the vessel from collapsing. 

No untoward symptoms followed the operation. The bandages were re- 
moved on the eighth day. The incisions had already united, the varices 
had been effaced, and the ulcer had cicatrised. To prevent a recurrence of 
the disease, before allowing the patient to use the limb, the starched ban- 
dages were reapplied. He continued to wear them while attending to his 
business, for nearly three months, and then left off every sort of dressing. 

I last heard from this patient in April, 1842. He had had no return either 
of the ulcer or the varices; and the discolouration of the integuments around 
the cicatrix of the ulcer had nearly disappeared. 

The treatment in the case now described being somewhat original; its 

40 Watson on the Pathology and Treatment of Varices. [Jan. 

simplicity, its efficacy, and the promptness and durability of the cure, gave 
me considerable satisfaction; and determined me to pursue the operation, or 
to improve upon it in other cases. I had been led by reflection to its adop- 
tion after perusing the able memoir of M. Bonnet on the subject of varices, 
in which he undertakes to show that in order to their effectual cure, it is 
necessary in most cases, to interrupt the course of the blood through the dis- 
eased vessels, at numerous points along the limb. The suggestion is not 
new, inasmuch as it had been practised upon at least as early as the days of 
Celsus; and in modern times by Hunter, Brodie, Davat, and others. But 
it is of more importance than would appear from the writings of any of these 
authors; and M. Bonnet has presented it in a manner so forcible, as almost 
to deserve the credit of originating it. 

Mr. Bonnet's modes of treatment in detail, however, I did not feel justified 
in imitating, sufficiendy aware that there are serious objections against the 
pins and twisted sutures, as well as against the caustic, employed and 
recommended by this author, and that without having determined the fact by 
experiment, the operation by numerous excisions appeared to have many 
advantages over these. 

In the first place it appeared to be more thorough and permanent in its 
effects; the pins as well as caustic often failing to obliterate the vessel, or to 
obliterate it permanently; and sometimes even failing to embrace it. 
Secondly, the immediate effects of the operation by excision did not appear 
likely to be serious, or attended with much pain; the wound usually healing 
by adhesion, or after slight suppuration. Whereas, by the other methods, 
sloughing and ulceration are necessary consequences. Thirdly, the cure 
appeared to be more rapid. Fourthly, by leaving the vessel in the same 
condition as after amputation or other ordinary operations involving a divi- 
sion of the veins; the process of excision, although it furnishes no immunity 
against either suppurative or erratic phlebitis, must almost of necessity be 
less frequently the cause of such accidents. 

Case V. — William Sutherland, of Canada, boatman, aged 21, was ad- 
mitted into the New York Hospital, May 5th, 1842, with an ulcer about as 
large as a dollar on his left leg, produced three years previously by an in- 
jury; and with a varicose condition of the internal saphena and its principal 
branches, on the same leg, existing two years. 

After admission he was kept in bed, with simple dressings to the sore and 
a roller over the whole limb, for about two weeks; by which time the ulcer 
had cicatrised. On the 21st of May he underwent an operation for the cure 
of the varices. 

The steps of the operation were the same as those detailed in case fourth. 
The veins were exposed, and the exsection of a portion of the vessels was 
effected at four different points, commencing just below the knee, and pro- 
ceeding downward, as in the former case. The principal peculiarities met 
with in this instance, independent of the loss of blood to the amount, per- 
haps, of ten or twelve ounces, were, first, that the veins lay deeper and 
were covered with a much denser layer of fascia; second, that at the upper- 

1843.] Watson on the Pathology and Treatment of Varices. 41 

most incision, in the course of the internal saphena, there was a concomitant 
vein lying over the principal one, that this smaller vessel was first exposed 
and taken for the main trunk; and that the principal vessel was separated 
from it by a very dense fascia, and was not exposed until after the division of 
the concomitant vein. The coats of all the vessels were found to be even 
thicker than in the foregoing case; and iheir inner lining was also corrugated 
longitudinally, and redder than natural. 

The mode of dressing the wounds after the operation, and the subsequent 
treatment of the case, were in all respects the same as in the other case. 
The bandages were not disturbed until the end of the second week. On 
removing them we found the patient's limb free from varices, and all the 
wounds united by adhesion. In a day or two afterwards the bandages were 
reapplied, and the patient was allowed to walk about. There was no ap- 
pearance of any return of the disease at the date of his discharge, June 19th. 

Any attempt to treat the foregoing case either by the use of pins or of 
caustic, must, as appears to me, almost of necessity have failed; first, from 
the fact that the internal saphena lay so deeply as not to have been readily 
discovered, and much less reached by either of these means; and secondly, 
from the fact that the concomitant vein which lay above it, and was at first 
mistaken for it, if obliterated by either of these modes of treatment, would 
have a tendency rather to increase than to diminish the amount of bl ;od cir- 
culating through the principal vessel, and thus to aggravate the disease 
rather than to cure it. 

Case VI. — Catharine Fitzgerald, of Ireland, a cook, single, aged 46, was 
admitted in the New York Hospital, March 5th, 1842, with numerous 
varices on both legs, but much the worst on the left leg. The disease was 
attended with an (Edematous condition of both limbs, and involved the 
smaller as well as the larger vessels. The minute veins of the integuments 
were in numerous patches so much dilated as to render the surt^ace purplish 
and arborescent. The disease had existed about five years. In consequence 
of the oedema and the burning and heavy sensation in the limbs vviien she 
remained standing for any length of time, she was unable to attend to her 
occupation. Her countenance was sallow, she was of a lymphatic tempera- 
ment; and on closer examination I ascertained that for some months past she 
had suffered from a too frequent and profuse menstrual discharge, her 
periods returning upon her at the end of every second week. 

Deeming the case, from this circumstance, an improper one for surgical 
interference, I directed her to be transferred to the medical department of the 
Hospital. Here under an appropriate course of treatment, (of which, how- 
ever, I have no minutes), she was relieved of this difficulty; and about the 
first of May, she returned to the surgical department, to be relieved of her 

The operation was performed on the 2 1st of May, on the same day as in 
the preceding case. There were five different incisions, two of which were 
on tfie external saphena and its branches, and three on the internal saphena 
and the vessels going from it, at their anastomosing points; all of them below 
the knee. The veins, though much dilated, were not so much hypertro- 
phied TiS in either of the former cases, and their inner lining was smooth and 
of its natural appearance. They lay immediately beneath the skin, imbed- 
ded in adipose tissue, and without the dense fibres or cellular coverings 


42 Watson on the Pathology and Treatment of Varices. [Jan. 

described in the former case. The patient lost little or no blood during the 
operation. The subsequent treatment was as before described. That is to 
say, the patient, in order to allay the pain of the incision, and to prevent 
constitutional excitement, was kept for the first twenty-four hours, under the 
influence of anodynes. About the fourth day, the patient having hitherto 
been free from pain or excitement, a small circumscribed swellini was ob- 
served about the middle of the thigh, attended with slight pain and redness, 
and lying in the course of the saphena major. A blister was applied over 
this; and after a dose of castor oil had operated, the patient was again put 
upon the use of anodynes. No further inconvenience ensued, the swelling 
gradually subsided, but left an indurated spot which continued for some 

The bandages were removed, and the incisions found to be cicatrised, at 
the close of the second week. The varices were now no longer visible, 
except that a few of the cutaneous venules were still apparent, giving to the 
skin the arborescent appearance already noticed. Tlie bandage was again 
applied, and the patient allowed to use the limb. She remaihed in the 
hospital up to the 16th of July, using the Hmb every day without any dis- 
position to a return of the disease. She would have submitted to an opera- 
tion in the vessels of the other limb, had I thought the severity of the disease 
there sufficient to have required it. 

The main peculiarities of this case were, that both the internal and exter- 
nal saphena and their branches were involved; and that this circumstance, 
contrary to the opinion of Bonnet, gave rise to no inconvenience. Other 
circumstances more or less worthy of notice, were that the limb was free 
from ulceration; that vast numbers of minute venules in all parts of the leg 
and foot, were proportionally as much dilated as the principal vessels, if not 
more so; that though tortuous, lengthened, and dilated, the vessels were not 
proportionally thickened, their coats having apparently suffered from simple 
passive enlargement. From the number of vessels involved, and from the 
extension of the disease to the ultimate branches of the veins, the operation 
was undertaken with less confidence of ultimate success, than the result of 
the case would have justified. 

Case VII. — Michael Neale, of Ireland, seaman, aged 29, was admitted 
June 21st, 1842, with a small ulcer on each shin, and varices on both legs. 
He stated that about five years previous, while in the East Indies, he had 
been confined to his bed by sickness for several months; after which, in at- 
tempting to walk, his limbs became swollen, and the varices soon afterwards 
appeared. Those on the left leg having been the largest from the first, were 
the first to give rise to ulceration. The ulcer on the other leg had existed 
about three years. Both of these sores had several times cicatrised and as often 
reappeared. Soon after the first occurrence of the varices on the left leg, an 
attempt was made to cure them by a deep longitudinal incision through the 
diseased veins near the upper part of the leg. The wound gave issue to 
very free hemorrhage, which returned every time the patient put his foot to 
the ground, for several days subsequently; but had no eff'ect in diminishing 
the disease. Both legs have ever since continued swollen; the varices are 
gradually enlarging. The distress attending these frequently obliges him to 
remain on his back, and neglect his business. 

1843.] Watson on the Pathology and Treatment of Varices, 43 

After his admission he was for a few days confined to his bed, with 
simple dressings to the sore, and a roller over each leg; and with laxatives 
and low diet to relieve any inflammatory tendency, and prepare him for the 

On the 25th of June, the operation was performed on his left leg. The 
varices were so numerous as to require nine different incisions; one of which 
was on the saphena major, a few inches above the knee, five upon the inter- 
nal saphena, between the knee and ankle; and three upon the external 
saphena and its branches, or the communicating vessels between it and the 
internal saphena, at their points of anastomosis. The veins though much 
dilated, were not generally as thick as usual; but in this respect they varied 
at the different points of incision. 

No unpleasant symptoms occurred. The dressings were removed at the 
end of the second week. The ulcer had healed and all the cuts but two had 
united by the first intention; and these two cicatrised soon afterwards. 

On the 20th of July, the disease in the left limb having been effectually 
cured, the patient underwent another operation on account of the varices on 
the right leg, the ulcer there having already disappeared. Three incisions 
only were required, all of them below the knee, the first in the internal sa- 
phena, the second on a branch of this, and the last on a mesh of varices at 
the posterior and lower part of the leg, in one of the main branches of the 
external saphena. 

At the end of a week the dressings were removed; the wounds had united, 
and the varices had disappeared. The patient was discharged, cured, August 

The most striking peculiarity of this case is, that in operating on the right 
limb, while attempting to pass the probe beneath the vein at the bottom of 
the second incision, the vessel was found in close contact with a cutaneous 
nerve of considerable size, which was indeed at first mistaken for the vein 
itself. The probe having passed beneath this, gave so much pain along the 
whole limb and down as far as the toes, that the mistake was at once detect- 
ed. In detaching the vein some caution was necessary to prevent this nerve 
from being injured. A similar complication by almost every other mode of 
operation, whether by subcutaneous section, by pins, or by caustic, might 
have led to serious consequences; whereas, by exposing the vessel, as in the 
mode described, the nerve may be avoided with scarcely any risk of danger. 

The other points of interest in this case, are — 1st, the great number of 
incisions necessary in the first operation; and 2d, the interception of the 
blood through both the external and internal saphenas, in both limbs. 

Case VIII. — Mrs. Cohill, widow, a native of Ireland, aged 40, a washer- 
woman of full habit, but in feeble health; had suffered from extensive varices 
for six years, which, as she thinks, were originally caused by hard work. 
In June, 1838, she first came under my care, having at that time had seve- 
ral severe hemorrhages from a small ulcerated spot just below the knee on 
the left leg. The bleeding had recurred every day for eight or ten days in 
succession, and had reduced her excessively. Having no means of treating 
her conveniently elsewhere, I had her transferred to the hospital. On the 
evening of her admission, whilst in bed, and with a bandage on the limb, the 
hemorrhage started anew, and before the nurse had time to summon the 

44 Watson on the Pathology and Treatment of Varices. ' Jan. 

house surgeon, the patient had lost, according to the reckoning of those 
about her, at least two chamber-potfuls of blood. A pin was immediately 
passed transversely beneath the bleeding vein at the point of ulceration, 
and compression effected by means of a thread, adhesive straps, a compress 
and roller. The limb was kept elevated for several days afterwards. The 
wound healed; there was no recurrence of hemorrhage from this point; and 
the patient in a week or ten days left the hospital, with the varicose condi- 
tion of her limbs as bad as at the time of her admission. 

In August, 1841, she had a return of hemorrhage from another minute 
point of ulceration at the upper and outer part of the right leg. This was 
arrested by compression, aided by a few days repose in bed. From that 
period up to the 13th of August, she had no return of bleeding; but the 
varices were continually increasing, giving her much pain, causing her feet 
and legs to swell, frequently preventing her from attending to her work, and 
oftentimes confining her to her bed. 

She called upon me, much alarmed, on the morning of the 15th of August, 
1842, stating that on the night of the 13th, while engaged in ironing clothes, 
one of the diseased veins near the outer ankle of the right limb suddenly 
burst with so much force as to throw the blood to the distance of several 
feet from her, and that before it was arrested she had lost at least a quart. I 
found the veins in both limbs exceedingly enlarged; but those on the right 
leg, in respect to the number and size of the varices, in a worse condition 
than I had ever before witnessed, presenting by their elevations and numer- 
ous convolutions, the appearance of a cluster of small snakes winding around 
the limb in all directions. The enlargement and varicose convolutions ex- 
tended throughout the whole length of the saphena major, involved all the 
superficial veins of the leg — and probably many of the venules in the sub- 
cutaneous cellular tissue, as well as in the skin. The irritation of the varices 
had excited a chronic pruriginous papular eruption, which formed large 
patches on different parts of the legs, but most extensive about the feet and 
ankles. She had often attempted to wear a bandage on the limbs; but, as 
she stated, it caused the veins to swell and to become very hard and painful, 
so that of 'laie she has not ventured to use it. For some days prior to each 
recurrence of hemorrhage, she had observed a small red sore spot over the 
vein from which the bleeding at length issued. The point from which the 
last bleeding issued was not larger than a pin's head, and had already ceased 
to be swollen or inflamed. I applied a compress over this part, and secured 
it with a roller, which w^as carried over the whole leg as tightly as the sen- 
sitive integument would bear it. On her way home, the pain of walking 
obliged her to rest at the house of a friend; and while there the blood again 
started with violence from the same point. The loss of blood at this time 
was greater than at any former period, and was arrested by the syncope 
which it induced. I saw her in the course of the afternoon. She was still 
in a state bordering on syncope. The varicose enlargement had to all ap- 
pearance been entirely effaced by the bleeding. The compress and roller 
were again adjusted. A slight oozing again occurred during the night. On 
the following morning she was admitted into the hospital. 

In a few days after admission, she complained of nausea, loss of appetite, 
and slight headache, and was somewhat depressed in spirits. She was con- 
fined to her bed, and put on low diet and laxative medicine. The catiiartic, 
however, rather aggravated her symptoms, irritated her stomach and bowels, 
and excited vomiting. These unpleasant feelings were relieved by small 
doses of Dover's powder. She could not at first bear much pressure on the 

1843.] Watson on the Pathology and Treatment of Varices. 45 

right leg — the veins being somewhat tender. An evaporating lolion was 
applied to them, which relieved the soreness. 

On the 20th of August, her unpleasant symptoms having subsided, 
(although her tongue Avas pale and glossy, and her spirits still somewhat de- 
pressed,) the operation was performed on the right leg. Seven sections 
were necessary; one of which was on the saphena major, just above the 
knee; all the rest were on the internal saphena and its branches, the lowest of 
them being just above the inner ankle, in a mass of varices with which the small 
vein that had given issue to the recent hemorrhages communicated, by wind- 
ing from below the outer ankle upwards and backwards, behind the tendo 

The vessels were unusually thin, and when once exposed and separated 
from their cellular attachments, they suddenly contracted, apparently to their 
natural size. In consequence of their tenuity, much caution was necessary 
to prevent them from being injured before isolating them. One of them was 
in fact perforated with a director by one of my colleagues, in attempting to 
pass the instrument under a thin layer of fascia which I was about to divide. 
At the bottom of one of the incisions, after passing the probe beneath a su- 
perficial vein, it was found that several other veins, still larger, lay some- 
what deeper, and were yet covered by dense cellular tissue. This was 
divided, and these deeper veins lying immediately upon the sheath of the 
muscles, were taken upon the probe with the other, and in due time divided. 
The dressings and treatment immediately after the operation, were tlie same 
as in former cases. 

About seven hours afterwards the pnlient became somewhat feverish, with 
headache, nausea, disposition to vomit, with pains in her back and lower 
part of the bowels. Her pulse was slow, however, and the appearance of 
her tongue as before the operation. A small dose of solut. sulph. morph. 
was administered and followed occasionally through the night with effervesc- 
ing mixture. The excitement was somewhat increased on the two follow- 
ing days; but it was soon ascertained that the patient's menses had appeared 
immediately after the operation, and her state of excitement was attributed 
to that circumstance. 

On the 23d the febrile symptoms had mostly subsided, but the patient had 
some soreness in the limb. The bandages were at first loosened, and at the 
end of a week entirely removed. Some of the incisions had closed by adhe- 
sion, one or two were suppurating slightly; but two of them had become 
more inflamed than usual, and threatened to excite severe inflammation in 
the loose cellular tissue of the calf of the leg. One or two small abscesses 
did in fact appear. At the close of the second week, the inflammation had 
entirely disappeared, and in the course of a few days afterwards, all the in- 
cisions hvid healed, and the patient resumed the use of the limb entirely free 
from varices except in the venules of the skin. But some of the convolutions 
of the veins were still visible by their bluish colour. She was discharged 
cured of the disease in the right limb, Sept. 16th, 1842. The patient was 
anxious to undergo the operation for the cure of the disease in the other leg, 
but the state of her family at home required her presence, and she was 
obliged to leave. 

The peculiarities of this case are — the number and extent of the varices; 
their complication with a pruriginous eruption; the frequency and alarming 
severity of the hemorrhages; the thinness of the coats of the vessels and 
their marked disposition to contract the calibre of the veins after being ex- 
No. IX. — January, 1843. 4 

46 Walson on the Pathology and Treatment of Varices. [Jan. 

posed and detached from their cellwlar envelopes; and finally, the febrile symp- 
toms and suppurative inflammation, following the operation. 

Thus far the operation by repeated exsections had been attended with 
uniform and marked success. Before proceeding to relate my two remain- 
ing cases, which terminated unfavourably, I shall offer some observations 
on the most striking peculiarities of six others, in which the operation was 
seven times performed by my colleagues; all with complete success. 

Case IX. — On the 7th of June, 1842, Dr. J. Kearney Rodgers operated 
on a patient, making six exsections in the course of the internal saphena 
and its branches, either over large varicose masses, or at distinct anastomos- 
ing points. His mode of operating consisted in cutting boldly down upon 
the veins, and removing portions of them, without previously elevating 
them on a probe, and finishing the exsection at one point before commencing 
the incisions at the points below. This method has the advantage of being 
more expeditious than the other; but, on the contrary, it exposes the patient 
to a greater loss of blood. 

In this case the disease had existed six years, and was complicated with a 
chronic ulcer. The patient, a currier, aged 24, had been operated upon 
about three years previously, by a physician in Connecticut, who applied a 
ligature upon the saphena major about one-third way up the thigh. The 
ligature was cut away on the fifth day: the wound healed by suppuration, 
and as soon as he began again to use the limb the varices were found to be as 
large and troublesome as ever. About a year after this he submitted to a 
second operation in the Massachusetts Hospital. Here caustic potassa was 
applied along the course of the vessel, on the skin, just below the point of 
the first operation. The result of this second operation was as ineffectual 
as that of the first. The vessel appeared to be as large and full at the point 
of the primary ligature as at any other place, and, as far as I could judge, the 
caustic had not produced an eschar of sufficient depth to reach the vein 
at all. 

After the third operation, the limb was dressed as before described; no 
unpleasant symptoms ensued. The bandages were removed at the close of 
the second week, by which time the ulcer had closed; the varices had disap- 
peared; almost all the incisions had cicatrised; one or two remaining open a 
few days longer. The patient was discharged cured on the 1st of July. 

On the 23d of June, Dr. R. operated on two other cases. The first of 

Case X., was an Irish porter, aged 38, who was brought to the hos- 
pital in a state of insensibility, and sinking from sudden and profuse flow 
of blood. The point from which the blood had issued was a small indurated 
and elevated ulcer over a varicose vein, at the upper and inner part of the 
leg. About seven years previously he had had a similar bleeding from a 
ruptured varix near the same point; and about two years ago a second 
bleeding from an ulcerated spot similar to the present. The first attack 
came on soon after heavy lifting; the second whilst he was getting out of 
bed in the morning; and this last, in which the loss of blood was more pro- 
fuse than in either of the others, came on whilst he was descending a flight 
of stairs. The varices had existed many years; were originally caused by 
hard labour. He had never had any large ulcer on the leg, and no other 

1843.] Watson on the Pathology and Treatment of Varices. 47 

sore than the small indurations that occur over the varicose swellings, and 
from which, by sudden giving way of the skin at a very minute point, all 
the hemorrhagies have issued. 

In this case there were seven incisions made in the internal saphena and 
its branches, and about an inch of the vein removed from each. The band- 
ages were removed at the end of a fortnight, by which time the cure had 
been effected. The patient was discharged on the 26th of July. 

Case XI. — Dr. R.'s third case had been several months in the hospital 
under treatment for varicose ulcers on both legs. The ulcers had preceded 
the varices, and these had existed about two years; and were worse on the 
left leg, whence they extended to the common saphena. The superficial 
epigastric vein on the right side was also slightly varicose. The ulcers had 
nearly healed at the time of the operation, which was performed only on the 
left leg. Four incisions were necessary, all on the internal saphena: three 
above and one below the ulcer. The progress and result in this case were 
the same as in the foregoing instance. The patient was discharged, cured, 
on the 25th of July. 

On minute examination of the exsected portions of veins in these two 
cases, I found them contorted, nodulated, and dilated, as usual. Their coats 
irregularly hypertrophied, were at some places nearly the tenth of an inch 
thick, and the outer coat in various points almost as hard as cartilage. The 
inner coat was corrugated into longitudinal folds of a pale pinkish colour, 
which changed after a few minutes exposure to a deeper red, giving the 
corrugated surface the appearance of muscular fibre. The valves were nei- 
ther thickened nor irregular; so far as I could judge, they appeared to be 
perfectly healthy. Besides the longitudinally folded appearance of the inner 
coat, there were also numerous transverse folds involving all the coats of 
the vessels, puckering them and throwing their sides into little pouches 
and irregular convolutions, which could not be effaced or straightened out, 
even after the vessels had been separated from the dense cellular bands on 
their outer surfaces that appeared to hold them in these irregular positions. 
The coats of the vein at the concave side of these convolutions, were usually 
thicker and harder than at other parts. These morbid appearances in the 
vessels, as well as in their cellular investments, appeared to have been the 
result of chronic inflammation. The vessels, after their removal and longi- 
tudinal division, appeared to contract considerably in their transverse mea- 

Case XII. — On the 23d of July, 1842, Dr. Hoffman operated on the 
right leg of a patient for the cure of varices complicated with an ulcer and 
with a chronic eczematous eruption, the result of the varices. The patient 
lost considerable blood. There were four points of incision; three on the 
inner saphena and its branches, and one on the outer. The dressings were 
removed on the 9th day: all the cuts, with one exception, had then been 
cicatrised and the varices had disappeared. 

Case XIII. — In this patient, (a German seaman of middle age and good 
general health,) Dr. Buck operated on both legs: on the right leg, August 
18th, 1842; and on the left, September the 17th, following. The varices 
were so prominent on the right leg, as to enable the operator to dispense 

48 Watson on the Pathology and Treatment of Varices. [Jan. 

with the use of the fillet around the lower part of the thigh. Saven inci- 
sions were necessary over the internal saphena and its branches. Subse- 
quent to the operation, the patient had an attack of inflammation of the ab- 
sorbents along the thigh, which soon subsided; but in the progress of the 
case he had considerable inflammatory reaction, and several of the incisions 
suppurated. In the second operation, (which was not performed until all 
the former cuts had closed and the patient was able to walk about,) there 
were four incisions: three on the internal saphena and its branches, one on 
the external. In the upper cuts on the former vessel, great masses of varices 
were exposed and found to be so convoluted and concatenated as to render 
the isolation of a single convolution less easy than the removal of the mass. 
No unpleasant symptoms followed this operation. The cure on both limbs 
was effectual. 

In this case the disease had existed since boyhood. The varices were of 
an enormous size, so much so, especially on the left leg, as to render the 
limb deformed. He had for years been subject to small indolent ulcers on 
different parts of his legs, usually in the course of the veins. At the time 
of the first operation his limb was studded with several small indurated 
swellings in a state of chronic inflammation, with dark spots in the centre, 
like the eschars resulting from dry gangrene, and these were seated in the 
integuments immediately covering varices more tender than the rest, and 
apparently adhering to the skin. The convolutions at some of the points 
of incision were so short as to give the veins the spiral and twisted appear- 
ance of a cork-screw. The veins in the right leg were much thicker and 
more numerous and convoluted than in the left. When divided their coats 
were found to be nearly the eighth of an inch thick, uniformly hypertro- 
phied and free from nodules: their inner coat presenting the appearance of 
pale and dense muscular fibres running longitudinally; and transverse ridges 
and depressions extending through both coats as in former cases. The 
valves of the veins were healthy. The f\iscia investing the vessels and 
bindinf the convolutions to one another, was very thick and strong, and 
appeared to be the result of long continued chronic inflammation in the cel- 
lular investment of the vessels, by which it had been contracted and con- 

Case XIV. — This was a patient with a chronic ulcer in the leg, which 
had given rise to varices in the course of the limb. The operation for the 
cure of these was performed as before described, by Dr. Cheesman. The 
vessels were divided at four difl^erent points. In consequence of undue ten- 
sion of the bandages, it was found necessary to remove them on the third or 
fourth day. The cure was as rapid and effectual as in the preceding cases. 

Case XV. — Susan Hyde, a negro woman, aged 33, a servant, was sent 
to me by a medical friend on account of varices on her right leg. The dis- 
ease had existed five years. In the interval she had had a chronic ulcer on 
the shin of the same leg, which is now cicatrised; had suffered from an 
attack of bilious fever, and within the past year, from what was supposed to 

1843.] Watson on the Pathology and Treatment of Varices. 49 

be a disease of the liver. But, although somewhat emaciated, she stated 
that she had recently enjoyed tolerable health. On the 9lh of September I 
had her admitted into the Hospital. After a ^evf days preparatory treatment 
she appeared to be in a favourable condition for the operation, which was 
performed on the 15th. 

A small ulcerated spot from which the hemorrhage had issued, as she 
stated, had first become sore about a month before admission, in conse- 
quence of a slight blow. It was seated in front of the ankle, on one of the 
terminal branches of the internal saphena. Just before the hemorrhages oc- 
curred she had suffered very acute pain in this part; the pain appeared to 
extend in the course of the veins all the way up to the thigh, and was fol- 
lowed by a sudden rupture of the vein at the point already mentioned, and 
the immediate loss of at least a pint of blood. A second hemorrhage oc- 
curred in three or four days afterwards, whilst she was in a recumbent posi- 
tion, and was much more profuse than the first. When I first saw her the 
varices were very numerous, and the veins greatly enlarged; but in conse- 
quence of the repose of the limb and the pressure of the bandage, at the 
time of the operation, they were greatly reduced so that the main trunk of 
the saphena in the thigh, and its continuation on the inner side of the knee 
downwards to the ankle, were the only vessels prominent beneath the skin. 
These to the finger were exceedingly resisting, and appeared to be consoli- 
dated. The application of the fillet was unnecessary, except for raising the 
vein at the lowest incision, and then it was applied around the leg just above 
this. There were but three incisions made, all of them on the main track 
of the internal saphena between the knee and ankle. The operation gave 
rise to scarcely sufficient hemorrhage to stain the instruments. About half 
an inch of the vein was removed at each incision, the last of which was at 
two inches above the point of ulceration. The vessels were absolutely 
empty, very much thickened, the inner coat corrugated as usual, and the 
calibre so contracted before the division, as scarcely to have admitted the 
smallest probe. 

Sept. \Wi. Patient had passed a comfortable night, and was still some- 
what under the influence of the anodynes which she had taken subsequent 
to the operation. Skin warm, pulse 120. The pain in the leg caused by 
the incisions had nearly subsided. No tension or tenderness either of the 
foot or of the thigh, above the bandage. 

ilth. The anodyne taken last night had not procured her much sleep. 
Her tongue was thickly coated, and rather broad and swollen; pulse 140, 
small and rather weak. Had recently taken a dose of castor oil, which was 
still operating. She complains of thirst, and has no desire for food. No ten- 
derness in the limb. She was permitted to drink weak lemonade. To-day 
for the first time, the starched bandage was applied over the simple roller. 
During its application she had some chilliness, which was attributed to the 
cool air from an open window near her, and was very transient. An ano- 
dyne was administered at night, consisting, as usual, of the solution of 
the sulphate of morphia, gtt. xxx. 

18^^. Had passed a watchful night without pain. Her general condition 
precisely as on the preceding day, except that there was some oedema of 
the foot, which when pressed was found to be rather tender; she spoke of a 
slight headache. The frequency of the pulse was the only symptom that 
appeared to indicate much constitutional excitement. I questioned her' 
closely in respect to her history and previous state of health, but could elicit 

50 Watson on the Pathology and Treatment of Varices. [Jan. 

nothing further from her than that her last menstrual period had just passed 
at the time of her admission into the Hospital; and that she had long been 
habituated to the use of opiates. The tenderness of the foot appeared to be 
caused by the tightness of the bandage. This was divided for a few inches 
upv/ards, and a looser one applied on the part. In the afternoon the patient 
had a rigor, which was followed by increased tension of the limb. The 
whole of the bandage was now divided, and a looser one applied. In the 
afternoon and until bed-time, the nurse informed me the patient appeared to 
be more comfortable than at any period within the two or three days past; 
but about midnight she began to moan and appeared to be in considerable 
pain. About 3 o'clock in the morning, supposing the patient required her 
assistance, the nurse arose, and to her surprise found her in a slate of col- 
lapse. The house-surgeon was instantly summoned. He had scarcely 
time to see the patient, and administer a few tea-spoonfuls of brandy, be- 
fore she expired. 

Post mortem examination, between eight and nine hours after death. 
The body was rather emaciated; the parietes of the abdomen corrugated as 
if by utero-gestation. The upper incision of the leg was in process of union 
by adhesion; but the two lower cuts were gaping and filled with dark fluid 
blood. The integuments for an inch or two around them, appeared to have 
been in a state of gangrenous inflammation, the cuticle being detached from 
the skin. The cellular tissue of the foot was partially infiltrated with serum, 
and the veins below the last cut were filled with dark fluid blood, and free from 
coagula. The portion of vein between the two lower cuts, which were per- 
haps three or four inches apart, was the only part of the venous system 
that appeared to be at all inflamed, being of a brighter red colour than the 
fluid blood contained in it; but free from coagulum, and from every thing like 
fibrinous or purulent deposits. Above the middle incision, the internal sa- 
phena vein was empty, and of the same colour as the small sections that 
were removed during life. There had existed a very large mass of varicose 
contortions in the saphena major at its upper third. The vein here was 
also found of a deeper colour than usual, being of a dingy brownish purple; 
and its inner coat had the muscular appearance so often noticed in other 
cases during life; but gave no unequivocal evidences of recent inflammation. 
The inner coat of the vessel throughout was hypertrophied, and could be 
raised in large strips from the outer coat, to which, however, it adhered 
rather firmly, and when raised and examined, did not appear vascular. The 
large veins between this point and the heart gave no evidence of disease 
whatever, except that they had assumed, probably by imbibition, the precise 
shade of the dark fluid blood contained in them. The only coagulum found 
in the veins, was a small mass in the external iliac vein, which did not ad- 
here to the coats of the vessel. The inner lining of all the large veins was 
perfecfly smooth and elastic, and all the valves were healthy. 

The heart presented no morbid appearances, with the exception of a 
fibrinous polypus, which extended from the right ventricle into the pulmo- 
nary artery. The upper lobe of both lungs was consolidated, and studded 
with numerous tuberculous deposits, mostly small. Some of these had de- 
generated into bone; and some of these bony tubercles were as large as peas; 
all of them of an irregular shape, and extremely hard. The right lung 
adhered firmly to the chest. The lower lobes of both lungs were free from 
tubercles, but were somewhat injected with mucus. In the midst of the 
tuberculous masses of the left lung there were two small deposits of laudable 

1843.] "Watson on the Pathology and Treatment of Varices. 51 

pus; in all amounting to about half a tea-spoonful; probably the result of a 
softening tubercle. There was an old cicatrix on the surface and near the 
upper extremity of the right lung. 

The liver was nearly twice as large as natural, and congested with fluid 
blood; as were all the large veins in its neighbourhood. The texture of the 
liver did not appear to be abnormal, either in colour or consistence. 

The vagina was filled with a sero-purulent fluid, which issued from it in 
profusion in the attempt to separate the uterus from it. The uterus itself 
appeared to be larger and heavier than natural. There was a small fibrous 
tumour projecting from its fundus. The uterine veins were numerous, 
dilated, and convoluted, as in ordinary varices. The left ovary was as large 
as a hen's egg, and had degenerated into numerous cysts, which, when 
opened on the following day, were found filled, some of them with a trans- 
parent yellowish gelatinous fluid, others with what appeared to be grumous 
blood coagulated. The inner surface of the uterus, when laid open on the 
following day, was found to have been in a state of inflammation. Its 
mucous lining was of a bright red colour, extremely vascular; the vascu- 
larity greatest at the fundus, and at the openings of the Fallopian tubes; 
and terminating below, within half an inch of the neck, in a small pro- 
jecting vascular growth, like an incipient polypus, about as large as a 
pea. The os tincae was puckered, fissured, and slightly gaping; and there 
was an old cicatrix just external to it, round, about a quarter of an inch in 
diameter, probably the result of a chancre long since healed. No other 
morbid appearances were detected. 

From the foregoing history it is evident that this patient must have con- 
cealed some of her symptoms prior to the operation, a circumstance by no 
means unusual in hospital practice; when, partly from the ignorance and 
inattention of the patients to their own feelings, and sometimes from a de- 
sire to deceive, we are often forced to draw our conclusions, both as to the 
nature and the causes of disease, rather from what we should expect, than 
from what we ascertain. 

The most striking features of this unfortunate case then are,' — a vitiated 
condition of the general health prior to entering the hospital, consisting in 
tuberculous deposits in the lungs, probably of long duration; an enlargement 
of the liver, also of long continuance; an inflammatory disease of the uterus, 
of recent date. Upon which supervened, after a trifling and almost blood- 
less operation, obscure febrile movements, characterised principally by a 
rapid feeble pulse, with heavily coated tongue, wakefulness, anorexia, and 
slight headache, which, after continuing for three days and a half, were sud- 
denly followed by collapse, terminating in death; the fatal issue probably 
hastened, if not actually induced, by the formation of a fibrinous concretion 
in the heart, which must have materially interfered with the circulation 
through the pulmonary artery. The blood in most of the large vessels was 
in a fluid state; neither of the wounds had suppurated, and there were no 
evidences of phlebitis, except in a small portion of the internal saphena be- 
tween the two lower incisions, which must have prevented the blood in this 
part of the vein from entering the'general circulation. 

52 Watson on the Pathology and Treatment of Varices. [Jan. 

Case XVI. — Thomas Donahoe, of Ireland, a labourer, aged 30, was 
admitted into the N. Y. Hospital, August 30th, 1842, with extensive varices 
on the left leg and thigh, existing ten years, and a chronic ulcer on the shin 
existing six years. For the last few years the disease had troubled him so 
much that he was obliged to remain idle about half the time. He was of a 
sanguine temperament, had since his youth been subject to frequent attacks 
of epistaxis, and at the time of admission was somewhat plethoric, but was 
otherwise apparently healthy. 

The saphena major, from the groin downward, was very prominent, 
about as broad as the patient's thumb, and the whole of its lower third 
thrown into irregular serpentine convolutions. Below the knee the varices 
were still more prominent, involving all the branches of the internal saphena, 
the main trunk of the external saphena, and numerous communicating 
veins, above and below the patella, as well as on the back of the leg. The 
whole limb was deformed by them; and the dilatation in the minute veins 
was such as to produce a general engorgement of the leg, a spongy state 
of the subcutaneous cellular tissue, and spots of arborescent blotches in 
the skin. The varices had never given issue to free hemorrhage; but he 
was subject to frequent extravasation of blood beneath the skin from the 
slightest bruise. The purplish spots thus produced often occupied the 
space of several inches square, continuing for two or three weeks, and then 
gradually disappearing. He had long been in the habit of wearing a roller 
on the leg, at first with partial benefit, but of late with no advantage. 

After admission he was put on spare diet and placed on his back, with a 
roller applied tightly over the diseased limb, and a saline cathartic was ad- 
ministered. Notwithstanding the continued pressure of the roller, and strict 
observance of the recumbent posture, the vessels at the day of the operation, 
September 3rd, were still as prominent as ever, enabling me to operate 
without the use of the fillet. Tlie veins were divided at five diflferent points; 
the first above the knee, one in the upper part of the external saphena; all 
the rest on the internal saphena and its branches, the largest of which ran 
along the calf of the leg. The incisions were rather freer than usual, and the 
veins were raised by a thread, instead of the probe, as in former cases. 
About two inches of the main trunk of the vein were removed at the incision 
above the knee, and a large mass of convolutions, intimately interlaced, from 
the inner and upper part of the leg. No bleeding of any account occurred 
until after completing the last two exsections in the upper part of the leg and 
above the knee; but before applying the straps and compresses here the 
patient lost perhaps more than a pint of blood. 

The points of interest observed in connection with the operation and exami- 
nation of the portions of the veins removed, were — 

1st. That the coats of the enlarged veins were not of equal thickness at 
the diff'erent points of incision, and that the thickening bore no relation to 
the degree of dilatation. Thus, the vessels in the thigh, enormously dilated, 
were but slightly hypertrophied; the thickness of its parietes was trifling in 
comparison to that of the large branches of the internal saphena below the 

2d. That the points at which the convolutions were the most numerous 
and agglomerated, were the points at which the greatest degree of hyper- 
trophy existed in the coats of the veins. 

1843.] Watson on the Pathology and Treatment of Varices. 53 

3d. That the thickening at each point in the course of the vein was regular 
on all sides, and free from the small nodules of lymph or cartilage, as well 
as from small irregular thin pouches in the coats of the vessel, as witnessed 
in former cases, especially in such as had given issue to several hemorrhagies. 

4th. The anatomical changes in the two coats were, as observed in other 
cases. The inner coat was marked by fleshy looking longitudinal fibres, and 
mottled at the various points of anastomosis with small purplish spots, as if 
by extravasation of blood between the two coats. The outer coat had the 
appearance of a thick and uniform layer of semi-diaphanous cartilage. The 
cellular investment beyond this was dense, and bound the vessels closely to 
the fascia and looser cellular tissue surrounding them. 

5th. A fact worthy of remark was the very great contractile power of the 
vessels when freed from the cellular envelopes by which they were held in 
a state of dilatation. Thus, the saphena major, before exposing it, appeared 
to be nearly an inch in diameter; and, when exposed, and before it was 
separated from the surrounding tissues, its diameter was still the same. But 
after isolating it from these, and before it was divided, the isolated portion 
contracted so much as to lead me to suspect that I had fallen upon a small 
collateral vessel; it was not more than one-fourth its former size, if indeed so 
much. The same fact was observed in the lower branches; but owing to 
the greater thickness of the parietes of these, the degree of contraction after 
isolating them was by no means so great as in the saphena major. 

6th. The subcutaneous extravasations, that had been of frequent occur- 
rence, must have issued from venules too minute to be secured, as these 
vessels, in numerous patches, were very much dilated without any apparent 
increase in the thickness of their parietes. 

About three hours after the operation the starched bandage was applied, 
■without any instructions from me to that effect, the usual practice having 
been to apply this on the day following the operation, after having allowed 
sufl^icient time for swelling. In the evening I found the patient complaining 
of pain over the tibia. He had already taken a full anodyne; another was 
ordered and instructions given for dividing the bandage if the pain con- 

Sept. 4th. The patient had been in pain all night, and had slept little or 
none. Early in the morning he became sick at his stomach and vomited. 
The house-surgeon now slit the bandages over the seat of pain. At 8 
o'clock A. M. I found him comparatively free from pain but with a rigor upon 
him. There was some tenderness at the left groin, which he attributed to 
the effort at vomiting. The lymphatic glands here were evidently enlarged, 
without any corresponding tenderness or swelling along the thigh. There 
appeared to be a distended vein under the integument at the point of the leg 
where the bandages had been cut, and the skin over them was slightly 
chafed. Another anodyne of solution of sulphate of morphia (gtt. xxx.) was 
administered, to be followed with spirit, minderer. gss. every second hour. 
At 2 o'clock, P. M. the patient was free from pain and disposed to sleep, 
pulse 80, tongue moist and clean. At 8 o'clock, P. M. he had taken another 
anodyne of half the former strength, and had continued the use of the dia- 
phoretic. He had been free from pain all day, with his skin moist and 

54 Watson on the Pathology and Treatment of Varices, [Jan. 

natural. He had an attack of epistaxis, but no return of nausea or vomiting. 
I found him asleep, with pulse at 100. A blister that had been applied in 
the morning over the enlarged glands at the groin, had drawn well. The 
chafed spot on the leg was now rather swollen and injected, but the enlarged 
vein had disappeared. 

5th. The patient had slept well. In the morning had a cathartic of castor 
oil which operated freely. In the evening had a rigor which soon subsided. 
The circulation was free in the limb, he had no pain, but a small circum- 
scribed swelling, like an enlarged lymphatic gland, had appeared on the 
track of the saphena at the middle of the thigh. A small blister was applied 
over this, and the other treatment continued. Hitherto, although with little 
relish, he had taken his regular meals, which were of the simplest kind. 

6th. Had slept as usual, and was free from pain; pulse about 100, tongue 
clean; still on the anodyne and diaphoretic treatment. In the course of the 
day he had sickness of stomach and occasional vomiting after eating, or 
after the effervescing draught which had been substituted for the spirit, 
minderer. At night he had another rigor, which was slight, and followed by 
no excitement. No tenderness or unusual swelling in the limb. The ten- 
derness and swelling in the lymphatic glands had been relieved by the 

7th. He had vomited once or twice in the early part of the night, but 
rested as usual. Disposed to wander in his sleep, but intellect clear at other 
times; pulse 102. 

9th. General condition as at last report. The bandages were partly 
removed. Over the tuberosity of the tibia, owing to irregular pressure, a 
small slough had taken place, and at the seat of the old and partly cicatrised 
ulcer on the shin the integuments had also given way, leaving a sore larger 
than the original one. 

lOth. The rest of the bandages removed. All the cuts, except one near 
the calf of the leg, were quite dry, and in process of healing. From this 
one there was a healthy purulent discharge. Simple dressings to the sores, 
dry lint to the cuts, and a many-tailed bandage over the whole. 

I2th. General condition gradually improving. No pain except at the calf 
of the leg where the adhesive straps exert an irregular pressure. The 
integuments here are inflamed, and a small abscess is about to form below 
the suppurating cut. The patient rests well, has no further irritability of 
stomach, and very little general excitement. A poultice was applied to the 
leg. The anodyne and diaphoretic course was still continued. 

i4fh. A small abscess that had formed in the back part of the leg was 
opened; the foot and lower part of the leg for a day or two had been some- 
what oedematous. He has little or no appetite, and is " romancing in his 
sleep." His skin is moist, and his pulse about 90, less full than formerly; 
and his tongue is heavily coated. 

I5th. Less inflammation, but more oedema in the limb. Pulse 88, soft 
and feeble; tongue moist and less heavily coated; romancing while asleep; 
skin moist and flaccid; slight emaciation. Patient has no pain, but speaks 
of inability to move the right leg. Simple dressings and a roller were sub- 
stituted for the poultice, and the patient was put on the use of bitter infusion, 
with a more generous diet. 

I6th. Patient has eaten with more relish, has slept well, is free from pain, 
and speaks of soon being able to get about. 

I7th, General condition as at last report, but in the course of the day he 

1843,] Watson on the Pathology and Treatment of Varices. 55 

took a dose of castor oil which sickened him, and in the evening the nausea 
and vomiting returned. 

\%th. I had not an opportunity of seeing him. The nausea and disposi- 
tion to vomit continued unchecked either by anodynes or the effervescing 

\9th. A pulse at 120 and very small, countenance anxious, skin bathed in 
perspiration, stomach still irritable. He spoke of severe pain in his hips. 
The discharge from the leg was rather free. He could not turn in bed 
without assistance. A sinapism was placed over his stomach, and lie was 
put on the use of sulphate of quinine, about three grains daily, with wine 
whey, broth, and beef tea, as much as he was disposed to take. 

"ZOth. Stomach quiet since the application of the sinapism; tongue dry and 
brown. The ulceration over the shin has extended and left a part of the 
tibia bare. 

^\st. Increased prostration, and increased pain in the hips. This morn- 
ing I observed the first joint of his right index finger much swollen and the 
integuments red, evincing the formation of what I supposed to be a secondary 
abscess. He attributed this to the habit of keeping the hand under his head 
while asleep. In the evening his tongue was dry and almost black, and he 
had slight subsultus, with muttering delirium during sleep; pulse still more 
frequent. He was put on brandy toddy. 

226?. Had taken nearly half a pint of brandy during the night. Prostra- 
tion in the morning less marked. The conjunctiva of the right eye engorged 
with blood. The stimulants were continued freely during the day, but 
towards night he began to sink rapidly, and he died about half past 7 
o'clock, P. M.; rather more than nineteen days after the operation. 

Autopsic examination^ 20 hours after death. Some of the cuts made 
during the operation had cicatrised; the others were all far advanced in the 
process of healing. There were two small openings that had been made for 
the discharge of matter, near the calf of the leg, communicating with an 
abscess there that contained a {ew ounces of purulent matter. With the ex- 
ception of a small part of the saphena major, all the veins of the limb, as 
well as those in every other part of the body, appeared to be free from 
inflammation; few or none of them even presenting the reddened appearance 
of their coats, so frequently the result of imbibition. The saphena major, 
for about five inches and a half above the uppermost incision, was thickened 
and adhering by lymphatic effusion to the surrounding tissues. It was dis- 
coloured internally, and blocked up with adherent and partially organised 
bloody lymph. But these morbid appearances terminated abruptly above, 
and were arrested here by an intervening valve. This valve itself was 
healthy, as were all the others above it. 

A small bloody and fibrinous coagulum was found extending from the 
right ventricle of the heart into the pulmonary artery. The heart in other 
respects presented no abnormal appearances. The lungs and the abdominal 
viscera were healthy. 

The principal seat of disease had evidently been the lymphatic system. 
The absorbent vessels running in vast numbers along the inner side of the 
thigh were thickened, consolidated, and opaque; in size and firmness 
resembling minute cords of catgut. The lymphatic glands were equally 
diseased. One of these, at the middle of the thigh, lay immediately upon 
the saphena vein, to which it adhered by firm fibrinous attachments. It was 
about an inch and a half long, oval, firm, and had numerous enlarged and 

56 Watson on the Pathology and Treatment of Varices. [Jan. 

at the groin, both superficial and deep-seated, were also enlarged, indu- 
rated, and agglomerated. The disease in the absorbents and lymphatic glands 
above this part had probably given rise to the most striking lesion in the 
consolidated absorbent vessels entering it from below, imbedded in condensed 
cellular tissue, and others extending from it upward. The lymphatic glands 
body, and one which elucidated many of the symptoms that occurred in the 
progress of the case. 

This consisted in an immense abscess extending in the course of the left 
psoas muscle, external to the iliac fascia, from the diaphragm to the groin, 
and passing at the groin under Poupart's ligament, on the inner side of the ves- 
els, downwards on the thigh, where it was arrested by the pectineus and adduc- 
tor muscles. The whole of the pelvic surface of the os ilium, as well as the 
portion of the os pubis forming the floor of this abscess, was exposed, bathed 
in purulent matter, but smooth and free from disease. The muscles lying in 
the course of the abscess, viz., the psoas, pectineus, and adductor femoris, 
were discoloured, softened, and approaching to a state of decomposition. 
The abscess, at its upper part, advanced close upon the vertebral column 
without actually reaching it. The vertebrae, so far as I could detect, were 

There was a large concomitant vein running nearly parallel with the 
saphena major in front of the thigh, with numerous branches extending ex- 
ternally and downwards. It anastomosed with the saphena, first, just above 
the valve by which the adhesive inflammation had been arrested, and again 
just before its entrance into the femoral vein at the groin. This concomitant 
branch was about one-fourth the size of the saphena major, and nearly, if 
not quite as large as the saphena itself, as seen in some subjects. It was 
healthy, but contained blood partially coagulated, as did also the deeper veins 
in the limb, and the large veins in other parts of the body. This vessel had 
probably enlarged subsequent to the operation, and must have been of mate- 
rial assistance to the deeper veins, in returning the blood from the limb. 

The details of this unfortunate case, which, towards its close, was looked 
upon as one of erratic phlebitis, throw much light upon some of the symp- 
toms that follow operations upon varices, and serve to show that other cir- 
cumstances, equally as important as phlebitic inflammation, must hereafter 
be taken into account in determining the propriety of any operation upon 
the veins. The fatal issue was evidently induced by inflammation of the 
absorbents, and not by phlebitis. 

The signs in the early part of the case, which subsided after the loosening, 
of the bandage, were probably owing to the extension of irritation in the 
course of the absorbent vessels, as indicated by the swelling and tenderness 
at the groin, and by the enlarged lymphatic glands in the middle of the thigh. 
It is diflicult to say how far this irritation was the result of the irregular and 
painful pressure of the bandage on the leg, or how far the direct efl'ect of a 
division of the absorbent vessels themselves during the operation. The sub- 
sidence of most of the constitutional symptoms for a few days before the 
close of the second week, shows that the inflammation of these vessels could 
not, at that period, have progressed above the groin. But the loss of power 
in the limb, the inability of the patient to turn himself in bed, the severe pain 
in the hips, the recurrence of rigors and sickness of stomach, the dry and 

1843.] Watson on the Pathology and Treatment of Varices. 57 

heavily-coated tongue, the emaciatiop, and the rapid and feeble pulse, all of 
which came on rather suddenly about the close of the fifteenth day, may be 
looked upon as indicating, at this period, a rapid extension of inflammation 
in the course of the absorbents, to the loose cellular tissue of the left lumbar 
region, eventually terminating in the recent abscess, which exhausted the 
patient, and was the immediate cause of death. 

Before closing these observations on individual cases, I may remark that 
they constitute only the severer instances of varices that have fallen under my 
-notice, and that, during their occurrence, I have had the management of nu- 
merous other cases. Some of these were the result of local injury, some of 
chronic ulcers, some accompanied tumours both simple and malignant, and 
some appeared to depend not so much upon an undue determination of blood 
to the lower extremities, from disease, severe labour, or the long observance 
of the erect position, as upon a natural laxity of fibre, either in the coats of 
the veins themselves, or in the tissues surrounding them. In several instances 
of this last class, the varices were less marked in the larger veins than in 
those of smaller calibre. They were nearly all observed in females of lym- 
phatic temperament, with superabundance of fat in the limbs; one of them, 
however, was a youth of twenty years of age. These cases were mostly 
treated with the roller and by keeping the limbs elevated. In a few, 
I pencilled the integument over the veins with tincture of iodine, but 
with no appreciable advantage. I shall close the report of cases with the 

Case XVII. — A coloured woman, aged 28, had for eight years suffered 
from a varicose swelling on the saphena major, just below the knee, which 
she stated to have been produced by an inflammation at the upper part of the 
leg, caused by resting on her knees in scrubbing. For six years the varicose 
swelling appeared to remain stationary; but some time since, after having 
placed her feet in cold water, she was suddenly aff'ected with severe pain and 
stifi'ness of the limb, and ever since the varices have been increasing. They 
now involve numerous branches of the saphena major on the leg, and extend 
around either ankle to the foot. She is subject to occasional attacks, during 
which the pain and turgescence of the limb are almost unsufferable. During 
these attacks she has been in the habit of puncturing the veins with a needle, 
in order to unload them. She has in this way often drawn half a pint of 
blood, or more, at a time. She has occasionally employed the common 
roller as a palliative, but from soon slipping and falling into irregular folds, 
it has given her so much uneasiness, that she can no longer resort to it. She 
was desirous of submitting to an operation for relief. From this, after the 
ill success above stated, I considered it my duty to dissuade her. I therefore 
resorted to another expedient. Requesting her to keep her bed for twenty- 
four hours with a common roller on the limb, in order to overcome the swelling, 
on the following day I applied several small portions of a common wax bougie, 
some longitudinally, others transversely, along the limb, over the course of 
the varices; I secured them in these situations, and then enveloped the limb 
in a starched bandage. On the succeeding day she was walking about; the 
bandage gave her no uneasiness except in ascending a flight of stairs. At 
the end of two weeks the dressings were still undisturbed. The patient ex- 

58 Watson on the Pathology and Treatment of Varices. [Jan. 

periences no inconvenience from the varices, but it is too soon yet to antici- 
pate the permanent result of the experiment. 

Part Second. I. Pathology. — The term varix has been employed in a 
manner altogether too indefinite. By some writers it is applied to a sort of 
thrombus or pouching tumour in the walls of a dilated vein, holding the same 
relation to the vein as an aneurism to an artery.* Others, using it in this 
sense, apply it also to varicose tumours formed by an agglomeration of con- 
volutions, either in a single dilated vein, or in a congeries of veins intimately 
entangled.! The true import of the term, as used by the ancients and 
others, is still more comprehensive. A varix, according to Galen, | is a vein 
tumefied or dilated with blood. In this sense it is also used by Paulus iEgi- 
neta,§ Pare,|| J. Cloquet,^ and others. It may be defined to be a vein mor- 
bidly dilated, and usually elongated, convoluted, and nodulated. 

II. Seat of Varices^ — Varices may occur in almost any part of the body. 
They have been observed on the head, on the arm; in the jugular veins, the 
subclavian, the vena cava, the azygos, the intercostal veins, the veins of the 
abdomen and pelvis, and the veins of the thoracic and abdominal parietes. 
They are most frequent in those parts of the body from which the blood 
returns with greatest difficulty to the heart, as in the superficial veins of the 
lower extremities, the spermatic, the hemorrhoidal veins. 

On the head and face the disease is of rare occurrence. I have seen it 
on the lips, and in one instance in the minute veins of the conjunctiva. In 
this case the vessel ruptured spontaneously, and produced a diffuse ecchy- 
mosis. As a secondary affection, it is occasionally seen here among the re- 
sults of chronic ophthalmia. The morbid growth on the conjunctiva, called 
pterygium, in some instances is evidently the result of a varicose enlarge- 
ment of the veins of this membrane. According to iEtius,** the disease may 

* Hodgson (on the Arteries and Veins, p. 538,) says, '*A small portion of a vein is occa- 
sionally more dilated than the rest, and forms a prominent tumour, which is denominated 
a varix." On the same subject M. Mon falcon (Dictionnaire des Sci. Med.) says, " elles sont 
h ces vaisseaux ce qu'est aux arteres I'anevrisme qu'on appelle vrai.''^ 

t "Varix, xtpcro^. Tumeur formee par la dilatation plus ou moins considerable et per- 
manente des veines." Begin, (Dictionnaire de Med. et de Chirurg. Prac.) Mr. S. Cooper 
gives the word this sense in his definition of it, whilst in his article on varicose veins, he 
gives it the more liberal application. 

t As given by Foetius, (CEconomia Hippocratis, appended to his Latin version of Hip- 
pocrates); also by himself, " varices vense dilatatae sunt." — (Epitome Galeni Operum, fol., 
Lugduni, 1643, p.459.) 

§ As adopted by Fabricius ab Aquapendente. 

II The small tumours, by some modern writers called varices, Pare distinctly charac- 
terises under the name of Thrombus. (Les (Euvres d'Ambrose Pare, fol, Paris, 1579, 
p. 484.) 

IT Dictionnaire de Medecine. 

** As stated by the translator of Hippocrates. 

1843.] Watson on the Pathology and Treatment of Varices, 59 

occur upon the eyelids; others have noticed it on the temples. Alibert* has 
found almost every vein of the head affected with varices. Portal* has dis- 
covered varices in the meningeal veins of the head; and, according to Mon- 
falcon,* they occur in the vessels of the pharynx and upper part of the oeso- 
phagus, and bursting here, give rise to extensive hemorrhage. 

In the veins of the arm, varices, as a primitive affection, are exceedingly 
rare. In a case recorded by J. L. Petit,* the disease occurred at the flexure 
of the arm. The patient vras fat, and no other vein being apparent, M. 
Petit, wishing to bleed the patient, was obliged to puncture the varix with a 
lancet. M. Rouxt saw a case under the care of Sir A. Cooper, in which 
the super^cial veins of the fore-arm were immensely distended. As a se- 
condary affection, however, varices are as frequent on the arm as on other 
parts. I have seen them here in connection with malignant tumours. Mon- 
falcon quotes a case from M. Cartier, in which all the superficial veins of the 
upper extremity were affected. The disease was congenital, but increased 
with the growth of the patient. At the age of twelve, "the varices were 
separated from one another by considerable depressions; the skin was bluish 
and livid, in a word, the arm and fore-arm appeared to be full of nodosities." 
This, I suspect, was an instance of aneurism by anastomosis, a disease in its 
origin very different from the one under consideration, but which, as is well 
known, may extend in the course of the large vessels, and in the end pro- 
duce all the appearances of simple varices, Aneurismal varix, or that variety 
of the disease which is produced by the passage of arterial blood from its 
proper vessel, through an unnatural opening into a vein, is of more frequent 
occurrence on the upper extremity than on any other part of the body, owing 
to the fact that the operation of venesection is now almost exclusively per- 
formed on the vessels of this part. 

In the veins of the neck the disease has been observed by Morand,:j; 
Cline,§ Portal,|l and M. Roux.^ Cases similar to that recorded by Morand 
are not unfrequently the result of obstructed circulation through the heart. 
The jugular veins in this instance were of the thickness of a man's thumb. 
The woman had suffered from palpitation, faintings, and continual pulsation 
in the jugular veins — "The right auricle of the heart was almost filled with 
a polypous concretion, the branches of which reached through the neighbour- 
ing veins quite to the jugular." In Mr. Cline's case, the patient was also 
a female, who had a large pulsating tumour in the neck, which burst, and 
proved fatal by hemorrhage. "A sack proceeded from the internal jugular 

* Dictionnaire des Sciences Medicales. 

t Medico-Chirurgical Review for July, 1832, p. 184. From Journal Hebdom. 

X As quoted by Morgagni, Letter xviii, article 9. 

§ Hodgson. Treatise on the Arteries and Veins, p. 539. 

II Dictionnaire des Sci. Med. 

IT Medico-Chirurgical Review for July, 1832, vol. xvii., new series, p. 184. 

60 Watson on the Pathology and Treatment of Varices. [Jan. 

vein; the carotid artery was lodged in a groove at the posterior part of the 

*'A man, aged 23, entered the Hopital de la Charite under the care of M. 
Roux. There was a tumour situated immediately above the clavicle, of the 
size of a pigeon's egg^ which was at first supposed to be an encysted tumour; 
it was firm, elastic, and did not pulsate. The patient had noticed it for about 
two years, but it was only within the last two months that it had given him 
any annoyance. Its true nature was not ascertained before the operation; 
when cut into, a quantity of coagulated black blood flowed out." Tlie swell- 
ing was now discovered to be formed by the dilatation of a venous branch 
communicating between the two jugulars. We are not told which jugulars, 
probably the deep and superficial of the same side. M. Roux put a ligature 
round it, and also around several thoracic branches. Fortunately the wound 
healed perfectly in a fortnight." 

Varices in the subclavian vein are extremely rare. M. Hodgson and others 
refer to a case of this recorded by Portal: the dilatation was excessive in the 
right subclavian vein, and terminated fatally by bursting into the cavity of the 

In the veins of the thorax varices have been observed by several authors. 
Morgagni,* on the authority of other writers, refers to several cases of 
varices of the vena cava, and other large veins attached to, or in the imme- 
diate neighbourhood of the heart, and gives the particulars of a case from 
Manfredi, of a varix of the vena azygos, which ruptured and terminated 
fatally. The vein, though contracted by the eff'usion, "had retained so much 
of its breadth, that it might be well compared to the vena cava. This dila- 
tation had extended itself to about the length of a span, and about the mid- 
dle of that length a foramen lay open, in the form of an ellipsis." Portalf 
has recorded three instances of this same condition of the vena azygos. In 
one of these the disease had also extended to the inferior intercostal veins, 
one of which was open. 

In the veins of the abdominal and pelvic viscera, varices occasionally occur. 
Internal abdominal hemorrhages, according to Monfalcon, are frequently caus- 
ed by the rupture of varices. In one of the preceding cases I have noticed a 
varicose condition of the veins of the uterus and its appendages. An instance 
occurred to M. Cruveilhier,± in which a varicose condition of the veins of 
the round ligament was found in connection with a strangulated hernia: the 
nature of the disease was made evident after the operation. The internal 
surface of the bladder is sometimes affected with varices, which rupture and 
give rise to hasmaturia; but the veins in the neighbourhood of this organ 
most frequently affected, are those that surround the prostate gland. In a 

* Letter xxvi, articles 28 and 29. 

t Monfalcon. Dictionnaire des Sci. Med. 

t Medico-Chirurgical Review, vol. viii., new series, p. 543. 

1843.] Watson on the Pathology and Treatment of Varices. 61 

patient who had suffered from a tumour of the luette vesicate, which had 
given rise to hypertrophy of the bladder, to calculous deposits, disease of the 
kidneys, &c., I found some of the plexuses of veins around the neck of the 
bladder and base of the prostate gland larger than ordinary goose quills. The 
vagina and vulva are occasionally the seat of varices. During parturition 
they are exposed to injury, and when ruptured, may lead to fatal hemorrhage. 
Cases of this sort have been recorded by Dr. Elsasser and others.* The 
veins of the urethra are sometimes affected in the same way, giving rise to 
symptoms analogous to those of stricture, and on the introduction of cathe- 
ters or bougies, giving rise to profuse and alarming hemorrhage. Such, I 
have reason to believe, was the fact in the following case: 

Mr. C, a Smyrnese, aged 40, had long suffered from a slight obstruction 
in the urethra, which was supposed to be an ordinary stricture. A few slight 
applications of lunar caustic had been made with apparent benefit. On the 
26th of March, 1842, the caustic was applied with as much caution as usual 
at the supposed seat of stricture, between five and six inches from the mea- 
tus urinarius. The amount of caustic dissolved was scarcely appreciable. 
The patient experienced no unusual symptoms until Sunday night, March 
27th, about thirty-two or thirty-three hours after the introduction of the in- 
strument. But feeling a disposition at this time to evacuate his bladder, he 
arose from bed, and, after some effort, began to evacuate clotted blood. 
During the night he was frequently aroused to repeat the same procedure, so 
that before the morning he passed nearly a chamber-potful of this clotted 
blood, mixed with fluid blood and urine. The discharge recurred about once 
an hour until the afternoon of the 28th, at which time I first saw him. He 
was pale, cold, agitated, and frequently shivering. He complained of throb- 
bing in his head, and sighed frequently and deeply. His pulse was weak, 
disposed to intermit, and ranging at sixty in a minute. His physician had 
administered rhatania extract internally, and had applied cold wet cloths to 
the perineum. The patient informed me that he could continually feel the 
blood, as he lay on his back, dropping, as he expressed himself, '•^ goutte par 
goutte'^ against the bas fond of the bladder. A solution of acetate of lead, 
fifteen grains to the ounce of water, was thrown into the urethra through a 
silver canula, previously introduced about four inches and a half into the 
passage. After injecting about four ounces of the solution into the bladder, 
and withdrawing the instrument, a compress was applied to the posterior 
part of the perineum, and directions were given, in case the hemorrhage re- 
turned, to introduce a tampon of ice into the rectum. The patient had no 
evacuation of the bladder for several hours afterwards. About midnight he 
again voided a small quantity of clotted blood and urine; the tampon of ice 
was then introduced. On the following morning he voided healthy urine, 
free from blood. He had no subsequent return of the hemorrhage. 

In the veins of the thoracic and abdominal parietes. — On the chest and 
upper part of the body varices are rarely observed, except as the effect of 
tumours and of carcinomatous diseases. In their simpler form they are not 
unfrequent on the walls of the abdomen. In one of the foregoing cases 
there existed a varix of considerable size in the superficial epigastric vein. 

* American Journ. Med. Sci. vol. xvi. p. 233 — 234. 
No. IX.— January, 1843. 5 

62 Watson 07i the Pathology and Treatmeyit of Varices. [Jan. 

Varicose tumours of immense size sometimes form on the lower part of the 
abdomen, especially in women who have borne several children, cases of 
which have been recorded by Severinus,* Boyer,t Bordeu,J and other wri- 
ters. § I have observed extensive varices on this part of the body in con- 
nection with ovarian tumours; and on the hips and loins, in connection with 
bony tumours. 

In the hemorrhoidal and spermatic veins.— These vessels, next to those 
of the lower extremities, are the most frequent seat of varices. In the veins 
of the rectum and anus, the disease receives the specific name of the piles, 
or hemorrhois, and is'of too much importance, and attended with too many 
peculiarities, both in a pathological and therapeutical point of view, to be 
spoken of incidentally. It may, perhaps, be the subject of a future essay. 
The same remark will apply, but not so forcibly, to the disease in the veins 
of the testicle and spermatic cord, where it constitutes varicocele, or, as it is 
still occasionally, and more properly called, cirsocele. 

hi the veins of the loiver extremity. — This part of the body is beyond all 
comparison the most frequent seat of varices. The main object of the cases 
reported at the commencement, is to illustrate the disease as it affects this 
part. Leaving then the history of varices as they occur in other parts of the 
body, we have now to speak of them in the vessels of the leg and thigh. 

III. Stages in the progress of varices. — When this disease in the veins 
of the lower extremity is the result of local injury, or of any morbid influ- 
ence acting directly on the limb, the varicose enlargements usually appear 
first in the neighbourhood of the affected part, or in the vessels that receive 
the blood directly from it. But they most frequently commence just below 
the inner side of the knee, and again in the vessels ramifying through the loose 
cellular tissue just above the heel, on either side of the tendo Achillis. The 
great saphena and its branches are more frequendy affected than the saphena 
minor, owing to the shorter course and peculiar termination of the latter. 
The deeper vessels are but rarely involved. They are not, however, ex- 
empt. In the auto psicexamination of Case XVI., I observed a very exten- 
sive varix behind the knee, in one of the deep veins, just before its entrance 
into the femoral. 

The changes produced in the vessels by the progress of the disease are, 
first, simple dilatation, which, though it may result from mere physical dis- 
tension, soon leads to a proper interstitial development, in the same way that 
morbid, and even healthy developments, are sometimes effected in other or- 
gans, as in hypertrophy of the muscles by healthy exercise of them; hyper- 
tropy of the heart, by mechanical distension and over-action; morbid deve- 
lopment of the bones of the head and face, and of the soft parts connected 

* De Recondita Abscessuum Natura, Cap. ix., § 13. 

t Maladies Chirurg., tome ii., p. 359. t Monfalcon. Diet, des Sci. Med. 

§ Medico-Chirurgical Review, vol. xix., p. 213. 

1843.] Watson on the Pathology and Treatme^it of Varices. 63 

with them in some cases of chronic hydrocephalus, and from tumours in their 

The next important change is an increase of length. This is in a still 
more marked decree the result of interstitial growth, and not of physical dis- 
tension. As the vessel grows in length, it falls into folds and serpentine con- 
volutions, and these occur most readily at points within which the vessel is 
under least restraint from fascias or dense cellular tissues, or other resisting 
envelopes. The v/alls of the vein about this period occasionally yield irre- 
gularly to the pressure of the blood, and form the small pouches which some 
have compared to aneurisms, and to which Pare gives the name of throm- 
bus. These several irregularities in the shape and course of the vessel, at 
first appear to be easily effaced; they disappear under certain movements of 
the limb; but by degrees they become fixed. The vessel contracts intimate 
adhesions to the surrounding tissues, which in their turn take on a diseased 
action, and become condensed into firm bands, extending from one fold or 
convolution of the vein to another, holding the vessel in its irregular shape, 
preventing it from exercising its proper elastic force for diminishing its cali- 
bre, and as the folds and convolutions at a particular point increase, binding 
them into one mass in the form of a varicose tumour. At this stage of the 
disease, by forcing the blood from the vessels, they may be made to collapse, 
so as to be no longer visible externally. A few days' repose, or the pressure 
of a bandage, may so far relieve the varices, as to lead us for a time to sup- 
pose that they have been entirely obliterated. The mistake, however, is cor- 
rected as soon as the pressure is removed, and the blood is allowed to de- 
scend into the limb. 

The next stage in the progress of the disease is an increase of thickness 
in the elastic coat of the vessel. This, in its healthy state, is always deli- 
cate, and never so firm as to prevent the vein from collapsing when deprived 
of blood. But in the progress of morbid development, it may become, even 
in the terminal branches of the saphena, thicker and firmer than the corre- 
sponding coat in tlie largest arteries. When examined under these circum- 
stances, it is found to have a pale bluish, grayish, or sometimes yellowish- 
white appearance, a cartilaginous hardness, and considerable contractile force. 
The cellular tissue surrounding it is also consolidated, sometimes nearly as 
firm and compact as the elastic coat itself. In some cases, especially in the 
early stages, the hypertrophy is uniform in the w^hole circumference of the 
vessel, though never so throughout its whole extent, being generally greatest 
at the point where the varix first appeared, or where it has been subjected to 
the greatest irritation. But in other cases, especially where the convolutions 
are short, numerous, or intimately involved, the elastic coat is thrown into 
nodules, and transverse prominences and depressions; the prominent points 
on the inner face of the vessel being usually the seat of nodules, or of an 
undue degree of hypertrophy, whilst at the depression on the opposite part 
of the vessel the parietes may be but little, if any, thicker than natural. 

64 Watson on the Pathology and Treatment of Varices. [Jan. 

Sometimes these nodules are so numerous in the course of the vessel, when 
felt beneath the skin, as to give a sensation similar to what might be produced 
by a chaplet of beads, or by a hard knotted cord. This feeling, however, is 
no evidence that the calibre of the vessel has been obliterated or obstructed 
with fibrinous coagula. Pressure, the horizontal position, or any other mode 
of emptying the vessels, may at this stage diminish the size of the varices, 
but will not even temporarily obliterate them. 

The inner coat appears to be the last to suffer. This at first is found 
smooth, shining, and diaphanous; at a later period it is thrown into reticu- 
lated depressions, and afterwards into minute longitudinal folds, giving it, 
with the reddish tinge which it has now acquired, the appearance of delicate 
muscular tissue. At this stage, though the inner membrane adheres closely 
to the elastic coat, and follows it through all its transverse ridges and de- 
pressions, it may, nevertheless, readily be torn in large patches from the 
latter, and these patches, when thus removed, show the membrane to have 
been thickened; the longitudinal folds disappear, the reddish tinge continues, 
but no vesssls are visible in its texture to the naked eye. 

In varices resulting from tumours and malignant growths, the coats of the 
veins are rarely or never thickened as above described, but are subject to the 
diseases of the surrounding tissues, and when inflamed, the blood coagulates 
within them, and may in this way prevent the loss of blood, on the super- 
vention of ulceration or sloughing. More frequently, however, their parie- 
tes give way before the blood coagulates, causing copious hemorrhage, which 
continues to recur as the disease progresses, and is the immediate cause of 
anasarcous swellings, sinking of the vital powers, and finally of death. But 
the coagulation of blood in ordinary varices is a rare occurrence. I have never 
had occasion to witness it independent of inflammation. As a result of inflam- 
mation, however, it is as likely to occur in varicose veins as in any other. 
Cases of spontaneous phlebitis supervening on varices, and terminating fa- 
tally, are reported by Mr. Lawrence and others. The strings and shreds of 
coagulable lymph mentioned by some writers as occurring in varicose veins, 
I have never witnessed on first opening into these vessels. In the autopsic 
examination of Case XVI. I noticed them, but only in the parts of the vein 
from which the circulation had been previously intercepted by the operation, 
and which were already in the process of obliteration. In short, the spon- 
taneous closure of varices, independent of acute phlebitis, is rarely or never 
noticed. The knotted and cord-like character of the vessel, when felt be- 
neath the skin, even if accompanied with a marked diminution of size, or 
following a previous state of unusual swelling and excitation, is not to be taken 
as proof of the closure of the vein. In Case XV. all these circumstances 
"were observed before the operation, and in some of the vessels afterwards; 
but in the autopsic examination the diseased veins were found pervious, and 
most of them apparently as much dilated as they had ever been. 

Varices accompanying ossific and osteo-sarcomatous tumours, are some- 

1843.] Watson on the Pathology and Treatment of Varices, 65 

times found in^bedded in grooves upon the surface of these tumours. Mr. 
Hodgson states that similar grooves are sometimes found on the surfaces of 
healthy bone in cases of ordinary varices. This I have not witnessed; but 
the induration of the tissues on either side of a varix, may give the finger 
when pressed upon the vessel, a sensation similar to what might be pro- 
duced by a depression in the bone. 

IV. Complications. — Often before the walls of the veins take in the state 
of hypertrophy above described, the languid circulation and increasing 
turgescence in the capillaries, lead to swelling of the limb. The skin and 
subjacent tissues are engorged with venous blood, infiltrated with serum, or 
consolidated with lymph. Ulcerations difficult to heal break out sponta- 
neously, or after the slightest injury, around the ankles or lower part of the 
leg; or pruriginous eruptions in the form of lichen, or chronic eczema, 
attack the flexures of the joints, the natural folds of the skin, or those parts 
of the limb upon which the varices are most troublesome. The cellular 
tissue is occasionally the seat of small indolent swellings that rarely suppu- 
rate, but occasionally take on gangrenous inflammation. These form imme- 
diately over varices, to which they adhere; and which, indeed, give rise to 
them. They usually bind the diseased vessel to the skin, and after ulcerat- 
ing or sloughing, give rise to sudden hemorrhage. The subcutaneous tissues 
are also occasionally the seat of sanguineous efl'usions, sometimes from the 
minute vessels, at other times from those of greater size, occurring either 
spontaneously or after trifling injuries. The varices themselves, already in 
a state of excitation, are peculiarly subject to sudden attacks of erethism 
bordering on subacute inflammation. This in turn leads to extension of the 
disease to vessels not previously afl^ected, or to its more rapid development 
in those that have already suffered; or it induces ulceration in their coats 
which sooner or later progresses to the surface, and gives rise to sudden 
hemorrhage. Finally, acute suppurative phlebitis may supervene sponta- 
neously in the progress of varices, and lead to fatal consequences; as in a 
case of Mr. Lawrence's, reported in the Lancet, (Jan. 20th, 1827, p. 527.) 
and in others, reported in the same journal, (Sep. 10th, 1825, p. 305.) from 
the Archives Generales. 

Among these various complications the ulcers are the most frequent; and if 
not the most dangerous, are at least among the most troublesome. Of these 
there are three kinds: first, the ordinary indolent ulcer, occurring about the 
ankles and lower part of the leg, indeterminate as to size and form, but al- 
ways obstinate. Independent of its connection with varices, and of its in- 
tractable nature, it has no characteristics to distinguish it from other ordinary 
ulcers. The second form is a minute perforating ulcer not much larger 
than the head of a pin, never larger than a pea, and is produced by the ex- 
tension of ulcerative action from the vein outward. It is surrounded with 
little or no swelling or induration: it gives rise to hemorrhage which may 

66 Watson on the Pathology and Treatment of Varices. [Jan. 

recur a few times before the ulcer closes. Finally, it cicatrises, and is not 
likely to reappear. The third form is also small, occurring in the centre of 
one of the small indolent tumours already noticed, either after an abrasion of 
this, or after the separation of a slough. It gives exit to hemorrhage, as in 
the second form; heals up spontaneously soon afterwards; but is likely to 
reappear during intervals of excitement in the vein beneath it, or after 

It has been remarked, perhaps correctly, that the loss of blood from 
varices, when moderate, has not the same prostrating effects as other he- 
morrhages. The blood in these vessels is habitually in excess, and the 
whole system often in a state of plethora, as indicated by attacks of epistaxis 
and liemorrhage from organs remote from the diseased veins. The function 
of sanguification appears to be exalted either to supply the loss caused by 
frequent bleedings from the varices, or to repair the deficiency in the rest of 
the body caused by the recession of blood to the dilated veins, in which it 
remains shut off, as it were, from the general circulation. This plethoric 
condition is strongly shown in those cases in which the simple application 
of a roller to the limb, or any other measure calculated to force the blood out 
of the varices into the general circulation, has led to congestion or inflamma- 
tion of distant organs, to hasmatemesis, diseases of the lungs, and other alarm- 
ing consequences. Madame Boivin, says Velpeau,* cites the case of a girl 
who when pregnant, could bring on an abortion at any time, by bandaging 
her legs, which were varicose. Mr. Freer's case, reported by Mr. Hodg- 
son, f in which a ligature applied to the saphena vein gave rise, within four 
hours afterwards, to violent pain in the left side of the chest, quick and la- 
borious respiration, inabihty to speak, and at length to vomiting of blood; 
and in which the alarming symptoms subsided on the removal of the liga- 
ture; and reappeared on repeating the operation several weeks afterwards; — 
is evidently another striking example of the same sort. 

V. Causes, — Without entering minutely into the special causes of varices, 
■we may remark that they most frequendy occur during the middle periods 
of life, and almost invariably after the age of puberty, in persons of both 
sexes habituated to severe labour, or protracted exercise on foot; or who 
have suffered from other affections determining an undue quantity of blood 
to the lower extremities, or preventing the blood already there from return- 
ing freely to the heart. 

In reference to their causes, then, varices are either primary or secondary. 
The first occur in persons of lax fibre, of lymphatic or sanguineous tempera- 
ment; the coats of whose veins are naturally delicate, who have a supera- 
bundance of fat in the limbs, whose superficial veins lie loose in the midst 
of soft cellular tissue, free from the restraint of sheaths or dense surrounding 

* Medecine Operatoire, tome 2d, p. 262. Paris, 1839. 
t Treatise on the arteries and veins, p. 551. 

1843.] Watson on the Pathology and Treatment of Varices. 67 

textures. The second may result from chronic ulcers, from cutaneous erup- 
tions, morbid growths, local injuries, spontaneous inflammation, or they 
may occur after long confinement to the recumbent position, or in the train 
of other diseases, especially of the abdomen; as in disorders of the portal 
system, ovarian and other tumours, the gravid uterus; and, as some believe, 
from obliteration of the larger veins. It should be remarked, however, that 
mere mechanical obstruction is never of itself sufficient to give rise to varices. 
The blood when impeded in its course through its natural channels, is almost 
immediately diverted into others, so that obstructions of this sort, instead of 
producing varices, are, in fact, among the most efficacious means of curing 

Mr. Hodgson has intimated that varices may be the result of rupture of 
the valves of the veins; and Sir Everard Home thinks that in varices the 
valves are thickened and contracted. I am not aware of any facts on record 
to establish these points. In every instance in which I had an opportunity of 
examining the veins, the valves were perfectly healthy. Nor have I been 
able to confirm an observation made by Boyer, that varices are most apt to 
appear immediately above the situation of the valves. The truth is, valves 
are not often found in the midst of varicose enlargements, except in the 
saphena major above the knee. Even in healthy veins their number and 
position are indeterminate. I have at times been led to suppose that they 
are less numerous in persons subject to varices than in others. But if dis- 
ease in the valves has not been shown to give rise to varices, the impairment 
of their function after the varicose dilatation has commenced, evidently tends 
to aggravate it. In Case XVI. after the saphena major had been divided, 
pressure applied immediately above the incision, instantly arrested the he- 
morrhage; but when applied at the distance of three inches above this point, 
it only served to aggravate it., The autopsic examination showed that a 
healthy valve situated between these two points, had not been able to pre- 
vent the regurgitation of the blood entering the saphena from a large col- 
lateral branch that opened into this vein above the valve. 

VI. Diagnosis. — Varices may be overlooked or confounded with other 
diseases. In the thorax of persons dying of phthisis they have been found, 
where no such complication had been suspected.* We have no means of 
forming even a probable diagnosis of their existence, during life, in any of 
the natural cavities; except so far as they may occur in connection with 
other varices in vessels leading immediately into these cavities. Even in 
the superficial vessels they are sometimes overlooked. In the feet and lower 
part of the legs of adipose women, they may give rise to considerable swell- 
ing, which may be attributed to serous infiltration, or to irregular deposi- 
tions of fat. At the groin, in the upper part of the saphena major, in the 

* Morgngni, loc. citut. 

68 Watson on the Pathology and Treatment of Varices. [Jan. 

superficial epigastric veins, or in the femoral vein, &c., they occasionally 
give rise to tumours, which may be taken either for aneurisms or for hernial 
protrusions. Instances of this sort have been noticed by Sir Astley 
Cooper,* Dupuytren,t Cruveilhier,!: and others. The diagnosis in such 
cases is readily effected by pressing on the disordered veins, at the distal 
side of the tumour. In the lower part of the neck the veins are sometimes 
observed to pulsate, and when varicose may be raisfaken for aneurisms, 
Morgagni in reference to these, says, " we may distinguish the veins I am 
speaking of from the carotid arteries, if we attend to their external situation, 
and the softness of their parietes; and especially if witli Morand we observe 
that upon pressing the finger upon them, that part of the vessel which is 
below the finger shall, according to the laws of the circulation, subside; and 
that part which is above is increased, or at least preserves its former disten- 
tion. "§ Dupuytren also described a pulsating varicose tumour at the groin, 
that might have readily been confounded with aneurism of the femoral 
artery. II Again, erectile tumours or aneurisms by anastomosis, when sub- 
cutaneous, may at times be mistaken for varices. Such I suspect was the 
fact in a case of reputed varices of the fore-arm, quoted by M. Monfalcon^ 
from M. Cartier. For the peculiar characteristics of these tumours I must 
refer to my essay on Telangiectasis.** 

VII. Terminations. — I have already had occasion to speak of the dispo- 
sition of varices to occasional attacks of turgescence or erethism, during 
which the hypertrophy of their coats progresses with rapidity. On the 
subsidence of this state, the undue amount of blood which it attracts towards 
the veins, forsakes them; they contract somewhat upon themselves, and 
may diminish their calibre so much, as in future to contain even less blood 
than naturally belongs to- them. This same mode of termination also proba- 
bly goes on in a more protracted manner in the ordinary process of the dis- 
ease, where neither erethysm, inflammation, nor ulceration, supervenes to 
interfere with the gradual hypertrophy of the coats of vessels. In persons 
who have recovered from one or two attacks of the venous erethysm above 
mentioned; and in others who have long relinquished the laborious habits 
that gave rise to varices; and again, in very aged people who had formerly 
suffered from these, we occasionally find that their former varices have so 
far diminished as to give them no uneasiness, and to be distinguished only 
by their corded and irregular feeling under the skin. 

The calibre of the vessels under the foregoing circumstances, is simply 
reduced in size; the second mode of favourable termination, is in absolute 
closure of the veins. This mode of termination I su-spect, is effected only 

* Lectures. t Medico-Chirurg. Rev. March, 1829. vol. x., new series, p. 575. 

I Ibid. vol. viii., new series, p. 543. § Letter 18th, section 11th. 

II Medico-Chirurg. Rev. March 1829, p. 575. 

IT Dictionnaire des Sci. Med. ** American Journ. Med. Sci. vol. xxiv. p. 24. 

1843.] Watson on the Pathology and Treatment of Varices. 69 

by the supervention of active inflammation. When inflamed, the inner 
membrane of the veins tlirows out coagulable lymph, which interrupts the 
course of the blood through them; the blood itself coagulates, and adheres to 
the parietes of the vessel; the vessel itself adheres to the surrounding tissues, 
and if the inflammation is arrested in this its adhesive stage, the fibrinous 
eff*usion within the vein gradually becomes organised, the coagulated blood 
is absorbed; and the vessel is converted into a ligamentous cord, which at a 
still later period is finally resolved into its primitive cellular tissue. But if 
the inflammation proceeds to suppuration, and is still limited to the varices, 
fibrinous eff'usions, and purulent collections form both on their inner and 
their outer surface; the integuments ulcerate, and after the evacuation of the 
pus the inflammation subsides, and the varices are finally obliterated, as 
under the former circumstances. 

Finally, varices may terminate spontaneously in death. The fatal result 
may be induced, first, by suppurative phlebitis, as in two cases already re- 
ferred to; the one in the practice ofM. Ribus, the other in that of Mr. Law- 
rence.* This mode of termination, occurring but seldom as a spontaneous 
result, is the most common in fatal cases after operations. The symptoms 
and anatomical characteristics of traumatic phlebitis, I have sufficiently illus- 
trated in another place. f 

Secondly, Varices may lead to fatal consequences by the direct loss of 
blood, as in Case III. A similar case is mentioned by Heister,:}: in which 
the patient bled to death in his bed. I have already referred to Morand's 
case, of rupture of a varicose jugular terminating fatally, and to Mr. Cline's 
case of a varix in the same vessel terminating in the same manner. In three 
cases reported by Dr. Elsasser,§ the patients, during labour, bled to death 
from the rupture of varices in the vulva. Four others are cited in the Ameri- 
can Journ. Med. Sci. (vol. xvi. p. 234.) in which women under similar cir- 
cumstances died of loss of blood from varices in the vagina and external parts 
of generation. Many writers, speaking of varices on the lower extremities, 
without reporting cases, allude to instances of fatal hemorrhage. It is incor- 
rect, observes M. Velpeau,|) to say that varices are unattended with danger. 
The contrary of this was sufficiently proved by M. Girod in 1814. Petit has 
demonstrated the serious eflects of ruptured varices. Two patients, mentioned 
by Lombard, died of these. Chaussier cites an instance of ruptured varix in a 
pregnant woman terminating fatally. Murat has given an account of a washer- 
woman who died suddenly of the same accident. In 1827 a similar case 
was mentioned at the x4cademy of Medicine. I saw, continues M. Velpeau, 
a countryman, in 1819, die of hemorrhage twenty-four hours after the burst- 
ing of a varix. The death of Copernicus was owing to this cause. MM. 

* London Lancet, Sep. 10th, 1825, p. 305; and Jan. 20th, 1827. 

t See my essay on secondary abscesses, Amer. Journ. of Med. Sci. v. xxi. p. 37. 

t System of Surgery, vol. ii, p. 344. § American Journ. Med. Sci. vol. xvi. p. 233. 

II Medecine Operatoire, torn. ii. p. 262. 

70 Watson on the Pathology and Treatment oj ranees. [Jan. 

Reis, Lacroix, and Lebrun have published similar facts. A pregnant woman 
under the care of M. Forestier, from the same cause, was reduced to the 
same extremity. To ihis list of M. Velpeau's I may add, that in Cases VIII. 
and X., already reported, the danger from hemorrhage was equally as immi- 
nent as in the pregnant woman last cited. 

Again, after operations the disease may terminate fatally, independent of 
phlebitis, by the extension of inflammation to the absorbents, with or with- 
out tlie concomitant formation of abscesses in the course of these vessels, 
'i'he absorbents are, indeed, intimately involved in most of the diseases of 
the veins, whether spontaneous or traumatic. In cases of spontaneous 
obliteration of the veins, attended with dropsical effusions, M. Bouillaud* and 
others! have attributed the effusions to the obstruction in the veins, the real 
cause of which, however, was more probably owing to simultaneous diseases 
in the absorbent vessels accompanying the veins. For, there are numerous 
cases on record to show that veins even of the largest size, and many of 
them together, may be completely obstructed without giving rise to osdema 
or dropsical effusions. " I have already observed," says Mr. Brodie,| in 
speaking of varicose veins of the lower extremity, "that there are some 
reasons for believing that the venous branches are less liable to be inflamed 
in consequence of mechanical injury than the trunks in which they termi- 
nate." The observation is correct, so far as it refers to the occurrence of 
inflammation, and is probably owing to the fact that the trunk of the saphena 
is surrounded by an immense number of absorbents, that suflfer under every 
operation upon this vessel, and participate in most of its diseases. In Cases 
VI. and XIII. the absorbents were evidently inflamed after the operation, as 
shown in the one by the enlargement of a lymphatic gland over the saphena 
major in the middle of the thigh; and in the other, by linear inflammation in 
the integuments and enlargement of the glands at the groin. In Case XVI. 
the fatal result was evidently induced by the extension of inflammation along 
the absorbents, and from them to the loose cellular tissue in their course along 
the psoas muscle. Such, also, was probably the cause of death in one of 
the cases given by Mr. Hodgson, the symptoms -of which were analogous to 
my case, and the autopsic examination of which evinced enlargement of the 
inguinal glands, without any visceral disorder, and with evidences of phle- 
bitis, to say the most, equivocal, and by no means sufficient to account for 
death. " The whole of the vein above the wound, as far as its junction 
with the femoral vein, was removed. Its internal coat was redder and more 
vascular than natural; no coagulable lymph or pus was effused into its cavity, 
nor was any other preternatural appearance observed in it."§ 

In the fourth place, death may be induced after operations, as in Case XV., 

* Lancet, June 26th, 1821, p. 407, from Archives Generales for May 1824. 
+ American Joiirn. of Med. Sci. vol. ix., p. 204, from Arch. Gen. for April 1831. 
t Medico-Chirurgical Transactions, vol. vii., p. 201. 
§ Diseases of the Arteries and Veins, p. 557. 

1843.] Watson on the Pathology and Treatment of Varices. 71 

by the excess of reaction, and subsequent collapse, in persons already much 
reduced by previous or existing disease. Here the fatal result falls into the 
general category of those from all other operations upon persons whose gene- 
ral health is equally depraved. I have known the same result from the re- 
moval of a toe, and in three instances from the application of ligature to small 
hemorrhoidal protrusions. It is worthy of remark, that in persons dying 
under these circumstances, we usually find firm fibrinous concretions in the 
heart. Are these the cause or the consequence of the collapse? To attri- 
bute them to phlebitis, without other evidences of phlebitic inflammation ac- 
companying them, is neither philosophical nor correct. 

Lastly, Death may ensue, after operations, independent of phlebitis, by 
the recession of blood from the varicose vessels into the course of the general 
circulation, a result most likely to occur in persons of plethoric habit, and 
immediately produced by the sudden engorgement or inflammation of one or 
more of the vital organs. Death, under these circumstances, is preceded by 
such symptoms of constitutional disturbance as would otherwise characterise 
congestion or inflammation of the organs upon which the onus of disease is 
fixed. The organs, perhaps, most frequently affected in this way, are the 
lungs. Hence the occasional detection of pleuritic efl'usion, pneumonia, and 
pulmonary engorgement in the bodies of those supposed to have died of phle- 
bitis, but in whom the veins are either healthy, or but triflingly affected. 
Some of the older surgeons were sufficiently aware of the dangers resulting 
in this way from meddling with extensive varices. "II est meilleur," says 
Pare, " de ne toucher aux inveterees, parce qu'elles preservent de plusieurs 
maladies, a cause que le sang regare aux parties nobles, dont s'ensuit ulceres 
et chancres et suffocations."* This observation, however, was not original. 
Galen, before him, had made the same remark: " Quod si venas illas turgen- 
tes melancholico humore quis moliatur excidere, periculum imminet, ne 
homo corripiatur melancholia: id quod fieri saepius est visum, non in varicibus 
modo, verum etiam in haemorrhoidibus, quas ex hujusmodi humore consis- 

Part Third. Treatment. I. General Indications. — In the treatment of 
varices surgical interference m,ay be requisite; first, on account of the ulcers 
and inveterate eruptions, induced by, or accompanying them; secondly, on 
account of the repeated and alarming hemorrhage occasioned by them; and 
not unfrequently on account of other annoyances, as pain, turgescence, and 
rigidity of the limb; conditions, it is true, not often compromising life, but 
sufficient, nevertheless, to prevent the patient from following his usual occu- 
pation, and to> render life uncomfortable. 

The modes of treatment of which we are about to speak, it should be here 
remarked, have reference, principally, to the disease as it affects the lower 
extremities. Some of them are, indeed, applicable to the disease in the 

* Les CEuvres, fol., p. 48J. t Epitome Galeni Operum. Fol. Lugduni 1743., p. 341. 

72 Watson on the Pathology and Treatment of Varices. [Jan. 

spermatic and hemorrhoidal veins; but varices in most other parts of the 
body either call for palliative treatment only, or are so situated as to be 
beyond the reach of art. A mere enumeration of the writers and surgeons 
whose names are connected with special modes of treating varices, would be 
no inconsiderable undertaking. Such of them as have given most attention 
to the subject, will be noticed as we proceed. 

There are three distinct groups of indications to be fulfilled in the treat- 
ment of varices. The first of these is to prevent engorgement of the limb, 
and without undertaking to cure the disease, to keep it from increasing, or 
from exciting ulceration, or other concomitant affections; or to relieve these, 
when existing. The second is, to render more effective relief by reducing 
the size of the vessels, without suddenly obliterating them. The third is, to 
obliterate the varices at once, and to force the blood into new channels. The 
means employed for effecting the first of these are purely palliative measures. 
Those for the second are not always successful, and are sometimes dangerous. 
Those for the third are more efficacious than the others; but, at the same 
time, painful in their application, and still less exempt from danger. 

II. Special Treatment. First. To prevent engorgement of the limb; to 
keep the disease from increasing, or from exciting ulceration, or other con- 
comitant affections; or to relieve these when existing. 

The most effectual mode of fulfilling these indications is by moderate and 
equal compression over the afiected part, aided, as occasion requires, by ele- 
vation of the limb, simple dressings to the sores, specific applications for 
arresting hemorrhage; detergent, anodyne, or cooling applications to the 

Compression. — The credit of introducing gradual and equal pressure over 
the whole of the affected limb, for the relief of varices, has been awarded to 
Avicenna. The practice is probably of more ancient origin. The caliga, 
or legging, of the Roman soldiery, may have been employed, among other 
purposes, for relieving or preventing varices. Fabricius employed it, made 
of dog skin, for this purpose. In more modern times it has given place to 
the laced stocking, or gaiter, either of chamois leather or of cloth. The 
common roller has long been used for the same purpose. For these Mr. 
Travers has substituted adhesive straps. The starched bandage may be at 
times advantageously substituted for either of them. 

Local Depletion. — Punctures, scarifications, or small incisions into the 
veins, for the purpose of unloading them, is a practice mentioned several 
times by Hippocrates,* and by some of the other ancient writers; and recom- 
mended by Pare,t Petit,| and other modern surgeons. In Case XVII. it was 
employed by the patient herself, suggested to her by her own sufferings, and 

* Sect. I. De Medico; also, Sect. VI. De Ulceribus. 

t Les CEuvres, fo!. Paris, 1579, p. 484. t As stated by Hodgson and others. 

1843.] Watson on the Pathology and Treatment of Varices, 73 

frequently repeated, during states of unusual fulness of the vessels, with 
temporary benefit. As a means of treatment it is rarely advisable. The 
object for which it is recommended by Petit, viz., the evacuation of coagula, 
is frequently hypothetical. And the punctures and incisions, small as they 
are, when practised upon diseased vessels, subject the patient to all the 
dangers of more important operations, without offering him an equal chance 
of cure. 

Second. To diminish the size of the vessels gradually and permanently. 
— Varices, as already stated, may in some cases be gradually reduced, if not 
actually obliterated, by a change from the habits or modes of life that give 
rise to them. This result will be more likely to ensue, when, to the change 
of habit, is superadded permanent and well regulated compression, with 
other adjuvants. But varices may be more rapidly, yet still gradually, 
reduced, by special modes of applying pressure, by exciting inflammation in 
the tissues surrounding them, or by other special modes of acting on the 
veins without dividing them. 

Direct pressure on the veins. — Fabricius was in the habit of applying a 
compound astringent paste along the course of the varicose vessels, covering 
this with a reed, the hollow of the reed corresponding with the convexity of 
the paste; and binding on this dressing with ligatures, or with a roller drawn 
tightly round the limb. " Thus," says he, " by the pressure, first of the 
roller, then of the reed, and by the astringency of the medicament, the 
varices have so far diminished as to appear to have been dried up." 

In Case XVII. I resorted to a process somewhat less complicated, which 
may be applied as follows: — Take a common wax bougie, somewhat larger 
than the medium size, cut it into pieces of an inch or two in length; secure 
these at the detached points along the course of the varices, (longitudinally 
where the vein is straight, transversely where it is thrown into tumours,) by 
means of small adhesive straps. Then secure the whole with a common 
roller, laced stocking, or starched bandage, which should be applied as 
tightly as the patient can conveniently bear; the ordinary bandage, or stock- 
ing being the best for the first few days; and the more permanent application 
afterwards, as soon as the swelling which usually accompanies the varices 
has subsided. 

Mr. Travers succeeded in obliterating a varicose cyst of the saphena, 
behind the inner condyle of the knee, by means of adhesive plaster, applied 
in strips around the limb with as much tightness as could be borne. " The 
vein took on inflammation, and the cyst became a perfectly solid tumour, 
which afterwards shrunk, and was perfectly obliterated. The inflammation 
was severely painful, and accompanied by extreme tension of the part, and 
with considerable fever."* 

Local irritants. — With a view to reduce the varices without obliterating 

* Surgical Essays. Philad., p. 190. 

74 Watson o?2 the Pathology and Treatment of Varices. [Jan. 

the vessels, Mr. Mayo* recommends the application of an escharotic, com- 
posed of equal parts of soft soap and potassa, to the integuments. More 
recently MM. Laugier,t Berard,| and a few of the English surgeons,§ have 
employed the Vienna paste, a compound of equal parts of quick lime and 
potassa, for the same piu'pose. These applications, whatever be the special 
mode of using them, may give rise to difTuse phlebitis, to hemorrhage, and 
even to fatal consequences; and, if not carried so deeply as to excite adhe- 
sive inflammation in the vessel, they necessarily fail. Mr. Brodie,|| with the 
same view, has advocated the application of blisters along the course of the 
diseased vessel; a measure, from what I have seen of it, less likely to suc- 
ceed than it is to prove injurious. 

I do not find that electricity has ever been employed by any of the sur- 
geons who have written on tlie subject of varices. A case is reported in the 
Lancet,^ of a midwife who employed it for the cure of the disease in the 
vessels of her own limbs, as she states, with much relief. 

The tincture of iodme, first introduced, I believe, by Mr. Herbert Finch** 
for the cure of varices, has recently found some favour with the profession. 
When applied of sufficient strength to act as a caustic to the integuments 
over the varices, it may perhaps be attended with some benefit. 

Third. To obliterate the varices at once, and to force the blood into new 
channels. — The anastomosis between the superficial veins of the lower 
extremity, as, indeed, between the veins in every other part of the body, are 
exceedingly numerous. Several of the largest vessels of the leg, including 
both saphenas, may be totally obliterated, without impeding the circulation. 
The blood, under these circumstances, is returned, at first, mostly by the 
deeper vessels, but, soon after the interruption, by numerous superficial 
anastomosing branches, as shown in Case XVI. Before these superficial 
vessels are sufficiently enlarged, the blood, indeed, has to seek the deeper 
channels; but the contraction of these from the action of the muscles obliges 
it to seek another course, external to the fascia lata, through which it can 
move at all times, free from the impediment of muscular pressure, to which 
the deeper veins are continually subjected, and which renders them, for the 
most part, empty during moments of active exertion. 

Aware of the ease with which the blood is returned by new channels after 

* Medico-Chirurg. Rev. vol. x. new series, p. 250. 

t Bulletin Chirurgical, 1839, quoted by Dr. Scralchley in Lancet, May 14th, 1842. p. 

t Gazette Medicale de Paris, Jan. 22, 1842. 

§ Dr. Scratchley, and Mr. Clay of Manchester. Lancet, July 18th, Aug-. 29th, Oct. 
17th, Dec. 12th, 1840, and July 24th, 1841. 

II Lancet July 5th, 1828, p. 446. IT Lancet April 5th, 1834, p. 44. 
** Lancet Aug. 24, 1833, p. 707. 

1843.] Watson on the Pathology and Treatment of Varices. 75 

its proper veins have been obstructed, surgeons have long been in the habit 
of attempting the obliteration of these veins when diseased; and for this pur- 
pose they have employed a great variety of measures. Among these may 
be enumerated laceration, cauterisation, excision, erosion, ligature, incision 
and its modifications, the seton, and special modes of compression between 
folds of the skin, with a vice or clasp, or with pins and twisted sutures. 

Laceration. This barbarous mode of treatment was in use among the 
early Romans, and was practised, as we are told, on Caius Marius, who, 
after submitting to it on one leg, refused to have it tried on the other. It 
was performed, according to Paulus, by elevating the varicose veins, and 
tearing them forcibly from their attachment. 

Cauterisation. The actual cautery is recommended by Celsus; but like 
the foregoing treatment, it has long since been rejected. 

Excision. The removal of varices by excision, was also practised by the 
ancients, as we learn from Celsus,* Galen, f and Paulus iEgineta-l 

\st. By multiplied incisions. This the Celsean method, is performed by 
dividing the skin, drawing the lips of the wound apart with small hooks, 
laying the vein bare with a scalpel and passing a blunt hook under it. After 
thus exposing the vessel at one point, the operation is to be performed at 
intervals of four fingers breadth along the whole extent of the varix. The 
first hook is then to be raised, and the portion of the vein resting upon it, is 
to be excised; and so with the rest, until all the exposed portions are re- 
raoved. The lips of the wounds are then to be approximated, and covered 
with agglutinating plaster. 

2c?. Preceded by ligatures. Galen operated in two ways; first, when the 
varix was small, by simply excising it; and again, where the vein was likely 
to bleed freely when divided, by first placing ligatures upon it, and then 
dividing it between these. § 

3f/. With temporary compression and subsequent ligature. Paulus 
iEgineta describes the operation on the saphena major above the knee. He 
commences by binding the upper part of the thigh with a cord, and directing 
ihe patient to walk about, in order to render the varix prominent. He then 
traces its course with ink upon the skin. He now directs the patient to lie 

* Lib. vii. Cap. xxxi. t Epitome Galeni Operum. De Methodo Medendi. Lib. xiii. 

X On the authority of Pare and Fabricius. 

§ The ear]y introduction of the lig-ature as a means of arresting hemorrhage from both 
arteries and veins, appears to have been forgotten of late. The follovi^ing is the whole of 
the passage in which it is spoken of by Galen. "Quod si inter nudandum appareat libi 
vas magnum, aut magnum exhibere pulsum, tutius fuerit vinculo id prius excipcre, mox 
quod in medio est, prsecidere. Sunto autem ejusmodi vincula ex materia aliqua minimi 
putrcscibili, potissimum si lis arteries sint excipiendas. Etenim quae caro in abscissis 
vasorum partibus coalescit, ea pro operculo est, atque ipsorum oscula claudit. Gluod 
quidem ubi factum jam eernimus, decidere tunc tuto vincula possunt. Ac sic etiam 
varices curamus.quaB dilatatse sunt venae, potissimum circa crura et testiculos."— Epitome 
Galeni Operum fol. Lugduni, 1643, p. 459. 

76 Watson on the Pathology and Treatment of Varices. yan. 

down, and ties a second cord just above the knee. Then, with a scalpel, 
he divides the skin over the part marked with ink; he next detaches the ves- 
sel from its membranous envelopes, seizes and elevates it with a hook, cuts 
it off, unties the cord, allows a certain amount of blood to flow when this 
can be done with safety, and then applies the ligatures above and below, 
which he passes beneath the vessel by means of a needle, and perhaps, also, 
through the skin, making them at the same time serve as sutures, for closing 
the lips of the wound.* 

Erosion. We have already spoken of the potential cautery, as recom- 
mended by Mr. Mayo, for partially obliterating the diseased vein. The 
difference between this mode and that long since recommended, (as we are 
told,)t by Pare and Guillemeau, is scarcely appreciable, except that the 
older surgeons applied the caustic so deeply, as at once to erode the coats of 
the vein, leaving a space between the open orifices, to be filled up by cicatri- 
sation. As a means of radical cure even this bolder use of the caustic is liable 
to failure, unless applied as recommended by Mr. Bonnet,^ along the course of 
the veins, at intervals of three or four inches; and even repeated, where the 
first application fails to reach the vessel. The dangers attending this mode 
of practice are numerous. It gives rise to abscesses along the course of the 
vessels, to alarming hemorrhage, to difluse phlebitis, and has resulted fatally. 

Simple Ligature. To Sir Everard Home v/e must attribute the institution 
of this practice. The ancients, as already shown, employed the ligature in 
connection with other means; but only for the purpose of arresting hemorr- 
hage. Home was the first to publish any account of it as a means, by itself, 
for removing varices. § Supposing them mainly to depend on thickening 

* It is remarkable that several recent writers give the credit of the operation here de- 
scribed to Ambrose Pare, whilst Pare himself, as shown by his marginal note, has evi- 
dently given the credit of it to Paulus. The mode of applying the ligature, however, as 
given by Pare, is more after the manner of Galen. Fabricius, from whom I have taken 
the operation, seems to have some doubt as to the exact mode in which Paulus applied the 

t Several authors attribute to Pare the first employment of the potential cautery in the 
treatment of varices. In the copy of his works to which I have access, I find no men- 
tion of this practice; at least, none in the chapter devoted to the subject of varices: and I 
am still more surprised that in another chapter to which M. Bonnet refers, (livre 13, chap. 
XX. p. 315,) he does not even so much as mention varices. The following, however, is the 
passage, cited by several writers, in which he speaks of the caustic, and which I am 
obliged to give on the credit of M. Bonnet. *' Autre moyen de couper les varices, c'est 
d'appliquer un cautdre potentiel qui rouge et coupe la veine, puis se retire en haut et en 
bas. Par ce moyen, il y demeure un espace vide oti aprds s'engendre de la chair, et puis 
la cicatrice qui sera dure et epaisse empechera la fluxion en bouchant le passage de ladite 
veine, et, par ce moyen, la veine variqueuse sera guerie." — Archives Generales, Mai, 1839, 
p. 48. 

t Memoire sur la Traitement des Varices. (Archives Generales, Mai et Juin, 1839.) 

§ Practical Observations on the Treatment of Ulcers on the Legs, &c., chap. ix. 

1843.] Watson on the Pathology and Treatment of Varices. 77 

and rigidity of the valves, which prevented these from occupying the wliole 
area of the vein, it appeared to him no small object to take off a part of the 
pressure of the column of blood, by establishing an artificial valve; and this 
\he did by applying a ligature to the saphena major near the inner side of the 
knee, just above the point at which the branches from the leg unite to form 
the common trunk. He appears, however, to have borrowed the practice 
from Mr. Hunter, who, in one case, operated in this \vay on several branches. 
As a means of cure, the simple ligature is frequently .effectual, but not uni- 
formly so. It has frequently proved fatal; and the dangers attending it are 
so numerous, that it has for the most part been abandoned. 

Incision. — 1st. Longitudinal Incision. This plan of treatment, intro- 
duced by Mr. Hicherand* in 1823, has had but few advocates. It consists 
in making a longitudinal incision of some inches in length, through the in- 
teguments and diseased vessel; and after unloading this by the escape of 
blood, filling the wound with lint; and allowing it to heal by granulation. 
2d. Transverse Incision. — This practice originated, so far as I can ascer- 
tain, with Mr. Brodie,t who, in speaking of it, observes: " I found it to be 
preferable to the use of the caustic, as the operation occasioned less pain^ 
and as (in consequence of there being no loss of substance) the wound was 
cicatrised in a much shorter space of time."! He soon, however, relinquished 
it for his simpler and safer operation, viz; Sc/. The Subcutaneous Inci- 
sion. — -This he performs with a narrow convex bistoury, which he introduces 
through the skin on one side of the varix, and passes in between the skin 
and vein, with one of the flat surfaces turned forwards and the other back- 
wards, unlil it reaches the opposite side. He then turns the cutting edge of 
the bistoury backwards, and in withdrawing the instrument the division of the 
varix is effected. He recommends this operation only when there are but 
few varices in the limb; and performs it on the branches, but never upon 
the main trunk of the saphena. I have already shown its liability to failure. 
It was at first looked upon as entirely free from danger. We are told, how- 
ever, that such is not the fact. "Division of the vein with a valvular 
wound of the integument is surdy no violent injury to the vessel, and yet it 
is occasionally f)llowed by fatal inflammation. "§ 

The Seton. This operation, invented by M. Fricke, is performed by 
transfixing the vein with a needle, armed with a single thread, leaving the 
thread in the wound, traversing the vein; and allowing it to remain there 
long enough to excite adhesive inflammation in the varix, and thus to con- 
solidate the vein. The procedure is to be repeated at two or three points 

* Philadelphia Med. and Physical Journal, vol. viii. p. 449, from Medico Chirurg-. Rev. 
March, 1824. 

t Mfdico-Chirurgical Transaction?, vol. vii. p. 195, et seq. 

t In other hands it has terminated fatally. See Velpeau, (Medecine Operatoire, vol. ii, 
p. 259. 

§ Medico-Chirurg. Review, vol. x. p. 251. December, 1828. 
No. IX. — January, 1843. 6 

78 Watson on the Pathology and Treatment of Varices. [Jan. 

along each of the vessels aiTected. This operation too, like most of the 
others, has been attended with fatal consequences.* 

The Elastic Truss. This is spoken of by Sir Charles Bell,t and Mr. 
CoUes.J The latter is said to have used it with considerable success. He 
applies the pad of a circular truss over the saphena major at the groin, with 
force sufficient to prevent the passage of blood through the vessel. 

The Vice, or Scretv Forceps. This instrument, applied by its inventor, 
M. Breschet,§ for the cure of varicocele, was afterwards used by M. Sanson 
in the treatment of ordinary varices. It consists of two parallel iron plates, 
cushioned on their inner face, which are approximated, or separated, by 
means of screws. For applying it, the vein must be elevated on a fold of 
integument, and then embraced between the two plates of metal, which are 
approximated by means of the screws, until they are sufficiently close to 
interrupt the circulation, or even to excite a slough, in all the parts em- 
braced between them. The application of this instrument is attended with 
much pain. The surgeon is obliged to shift it frequently from point to 
point, along the track of the vein. If not applied with sufficient force to 
cause a slough of the skin, it is not likely to produce a permanent closure of 
the vessel. From the trials which I have seen with this instrument, in the 
practice of M. Sanson, I should never dream of using it. 

Subcutaneous Stricture. There are several distinct modes of interrupting 
the circulation through the vessel, by pins and ligatures, without exposing 
it; all of them of recent origin. 

1st. M. Davat's Method.W This surgeon commences by applying a tem- 
porary bandage just above the knee, and then requiring the patient to walk 
about for a few moments, in order to distend the varices. The patient then 
sits down; and the surgeon elevating the saphena major in a fold of integu- 
ment, passes a needle transversely tiirough the skin, beneath the vessel, and 
so on out at the opposite side. A second needle is next to be carried 
through the skin and the coats of the vein, under the first pin, and at right 
angles with it; and then brought again through the vessel and integuments 
to the surface, thus puncturing the vein at four points; and pressing it so 
firmly against the first pin, which lies under the vessel, as to arrest the 
course of the blood through the vein. These pins are now to be secured by 
a thread, in the form of a twisted suture, which is not to be applied very 
tightly; and allowed to remain until they become loosened by the ulcerative 
process, and then removed. If the first operation do not remove the whole 

* Velpeaii, Medecine Operatoire, vol. ii. p. 269. 

t Lecture, ia London Medical Gazette, vol. xiii. p. 428. 

X Velpeau, ul supra., p. 266, and Library of Practical Medicine, 2d edition, Pliila. vol. 
ii. p. 625. 

§ American Journ. Med. Sci. vol. xvii. p. 234. 

I) Du Traitement Curatif des Varices. Par Davat, 8vo. Paris, 1836. See also review 
of the work in American Journ. Med. Sci. vol. xx. 460. 

1843.] Wz.{8oxi on the Pathology and Treatment of Varices. 79 

of the varices, he repeats it afterwards at a few points, in the branches of 
the saphena, lower down. This operation is less dangerous than that by the 
seton; but it has, nevertheless, led to fatal results.* 

^d. M, Velpeau's Method.] This surgeon uses but a single pin for 
strangulating the vessel at a given point. This he passes transversely be- 
neath the vein without puncturing it, precisely in the same way as that prac- 
tised by M. Davat for the passage of the first pin. But he repeats the pro- 
cess at two or three points upon the saphena above the knee, and upon all 
the dilated branches on the leg and foot; using eight, ten, or even fifteen 
pins upon the same limb. Sometimes, however, says he, two or three ap- 
plications are sufficient. After thus inserting the pins, he embraces the ex- 
tremities of each of them in a circular ligature, which is to be tied with 
sufficient force to strangulate the portion of integument and vein resting upon 
the pin, and to cause it to slough. With this practice Mr. Velpeau was at 
first remarkably successful, having had more than a hundred cases before 
he met with an instance in which it terminated fatally. Of late, however, 
his success has not been so great; and it is now conceded that this opera- 
tion is as dangerous as the rest. In one case that terminated fatally, it was 
found that the pin had been so placed as not to interrupt the track of the 
vessel. I Such indeed is likely to be often the case, especially among the 
lower branches of the saphena, where, in consequence of the induration of 
the tissues, it is sometimes impossible to raise the vein sufficiently to allow 
the pin to be passed transversely under it. 

3fZ. 31. Regnaud''s Method.^ This consists in passing a thread, by 
means of a needle, transversely under the vein; applying a roll of basilicon, 
or of wax, or a small graduated compress, on the integuments immediately 
over the vessel, and then drawing the ends of the thread tightly over this, 
and tying them in a slip knot. The ligature in this way may be tightened 
or loosened at pleasure. It is not so likely to be efficacious in obliterating 
the varix as either of the two former methods. 

Ath. M. Ricord''s Method.\\ This process has been more particularly used 
in reference to varicocele; but it is also applicable to varices on the lower ex- 
tremity. It consists in passing two ligatures transversely; the one beneath, 
and the other above the level of the vein; but both below the skin, and 
traversing the integuments through the same openings. When thus applied 
they are lo be tightened, by tying their extremities together with sufficient 
force to strangulate the vessel. 

III. Appreciation. — The foregoing summary of operations, constitutes a 
formidable list, sufficient in itself to show the difficulties and dangers both of 
the disease itself, and of the measures that have been devised for overcoming 
it. Severe as some of these measures are, they are all subject to failure; 

* Velpeau, loco citat. p. 270. . t Loco citat. p. 271. 

X Mcdico-Chirurg. Review, vol. xxxvi. N. S. p. 556. § Ibid, p. 275. 

II Amer. Journ. of Med. Sci. vol. i. new series, 1841, p. 516. 

80 Watson on the Pathology and Treatment of Varices. [Jan. 

and with the exception of simple compression, and one or two other means, 
even less efficacious than this, there is not one of them thus far practised to a 
sufficient extent, to prove its efficacy, that has not led to fatal consequences. 
Nay, even pressure itself is not practised at all times vi'ith impunity. Some 
of these operations are, doubtless, intrinsically more dangerous than others. 
But their danger is in proportion neither to their efficacy, nor their apparent 
severity. It holds a more exact relation to the susceptibility of the veins 
already diseased, to an aggravation of their morbid action; to the state of 
these veins before the operation; and to the patient's general health at the 
time of submitting to it. 

It is to be regretted that we have no statistics worthy of the least depend- 
ence, for establishing the proportionate mortality that has attended opera- 
tions upon diseased veins. Those who have published the results of their 
own experience, have almost invariably presented us with a striking array of 
successful cases, in order to set off some new or favourite invention, leaving 
the counter-stroke of failures and fatal censequences, to be either guessed at 
or heard of accidentally from others. 

A principle of much importance, one upon which any operation, to be 
successful, should be founded, is the necessity of interrupting the circulation 
at more points than one in the course of the varicose vessels, and of multi- 
plying these interruptions in proportion to the extent of the varices and the 
freedom of their anastomoses. This, though evidently the principle upon 
which the operation of Celsus was founded, appears to have been forgotten 
for a time, until the attention of the profession was again called to it by M. 
Bonnet. Impressed with the importance of it, and believing, as I still do, 
that a vein is less likely to become inflamed after a clean section, than after 
any other operation upon it; and rejecting the caustic, as recommended by 
M. Bonnet, I undertook the operation as detailed in the foregoing cases. 
But if the result of these bears out the importance of this principle, they 
also show that a clean cut cannot be made through a diseased vein without 
endangering the life of the patient. 

Still the disease is a dangerous one; or, if not dangerous, troublesome 
and distressing. What then is to be done for it? 

If called upon to treat a varicose limb, free from complication either with 
ulcers, eruptions, local inflammation, or constitutional disturbance; until 
some means is discovered more simple and efficient than any yet employed, 
I should treat it with the view of fulfilling the second indication, as I have 
described under the head of direct pressure, and as practised in Case XVII. 
If there be an ulcer, I would elevate the limb; dress the ulcer as any other 
■under similar circumstances, independent of the complication; apply a 
simple roller to the limb; and after curing the ulcer, treat the varices as be- 
fore. Are there eruptions; are the veins turgid and painful; or is there any 
local inflammation complicating the varices? Treat the one or the other of 
these as independent affections; by elevating the limb; applying deter- 
gent, anodyne, or antiphlogistic lotions, or other similar applications; and 

1843.] Stewardson on Smallpox, 81 

after curing or relieving these, attend to the varices. Is there hemorrhage? 
Elevate the limb; keep the patient quiet on his back; apply a compress and 
roller until the ruptured vein has healed; and afterwards attend to the varices. 
In a word, whatever be the complication, palliate the disease until this is 
overcome; and then undertake the treatment of the varices, by attempting to 
effect their gradual and permanent diminution. 

Art. IV. — Remarks upon the cases of Smallpox admitted into the City 
Hospital during the years 1840, 41, and 42. — By Thos. Stewardson, 
M. D., Physician to the Institution. 

Towards the close of the year 18^9 a few cases of smallpox made their 
appearance in Philadelphia, and in February 1840 the city hospital was 
opened for their reception. This hospital is situated upon an elevated piece 
of ground called Bush Hill, in the neighbourhood of the city, and is admi- 
rably calculated, from its position and the facilities for thorough ventilation, 
to accommodate patients labouring under contagious diseases. The number 
of patients admitted from the period when the house was opened until the 
2d of August, 1842, when it was again closed, was 281. Of this number 
one entered as nurse to her child, a few laboured under measles, &c. The 
others, amounting to 266, were cases of variolous disease, which assumed, 
in the majority, the form of true smallpox, in others that of varioloid, and in 
a few presented such characters that it was difficult to determine to which 
of the two they properly belonged. These last were entered in the register 
as doubtful, and it is possible that among them a very few may be included 
which were not properly variolous. The exact numbers and mortality were 
as follows: 

Smallpox. Varioloid. Doubtful. 

161 73 .32 

Deaths 41 3 

From this it appears that the mortality in the true smallpox was about one 
in four, a proportion of deaths vastly less than that of the epidemic of 1823 
and 1821, as described by Drs. Mitchell and Bell, and in which more than 
half of the unprotected cases reported by them died. In the London small- 
pox hospital, according to Dr. Gregory, the average mortality of twenty-five 
years prior to the introduction of vaccination was thirty-two per cent., 
and that of the late epidemic of 1838 about thirty-six per cent., ex- 
cluding the modified form of the disease. In the epidemic already referred 
to, as described by Drs. Mitchell and Bell, it was observed that the African 

82 ^ Stewardson on Smallpox, [Jan. 

race seemed to be peculiarly obnoxious to the disease, the actual number of 
people of colour brought to the hospital, as well as the proportionate mor- 
tality being greater among them than among the whites, tlie deaths among 
the former being q^ four to six cases of the disease, and amongst the latter 
as two to four. Of the 266 cases observed by me there were 152 whites, 
and 114 coloured; the deaths among the former being 24, and among the 
latter 20. If we take merely the cases of true smallpox, they stand as fol- 

Whiles, 79 Coloured, 82 

Deaths 22 19 

From hence it appears that the proportionate mortality in the cases under 
consideration was nearly the same amongst the coloured as amongst the 
whites. Of the comparative liability of the two colours to be attacked by 
the disease I have no means of judging, the relative numbers admitted into 
the hospital being evidently no test. 

The influence of vaccination in modifying the severity of the disease, will 
be seen from an examination of the following table. In endeavouring to de- 
termine whether the patient had been previously successfully vaccinated, he 
was usually interrogated with care in reference to the point, and the arms 
examined in order to determine whether any, and what kind of mark, 
existed. Still, in some cases, it was difficult to settle the question certainly, 
and in others, as, for instance, when the patient entered moribund with an 
extensive eruption, it was at times impossible to obtain any information upon 
the subject. Inoculated patients were so rarely met with that this point of 
inquiry was at times neglected; and some of the patients are merely entered 
in the register as not vaccinated. Had any of these, however, laboured pre- 
viously under inoculated or natural smallpox, the fact could scarcely fail to 
have been known, and I have therefore placed them under the head of un- 
protected patients. A considerable portion of those placed below under the 
head of doubtful or unknown were, in all probability, unprotected. 

Unprotected. Vaccinated. Unknown or doubtful. Inoculated. Inoculated or vaccinated 
Total 113 97 51 2 3 

Deaths 30 4 10 

Of the four deaths after vaccination, one occurred from pneumonia, two 
days after the patient's admission. The variolous disease was mild, the 
pocks few in number, the pneumonia being indeed the principal affection, and 
evidently independent of the former. The results of the above table are 
clearly calculated to confirm our confidence in vaccination, especially when 
we reflect how comparatively small a portion of those who have been vacci- 
nated contract smallpox, even in the modified form; as in the present day in this 
city the whole number of })ersons vaccinated greatly exceeds that of the unpro- 

1843.] Stewardson on Smallpox. 83 

tected. Besides, it can hardly be doubted that even the smail mortality 
which now occurs after vaccination might be greatly lessened by the prac- 
tice of revaccination, not because the influence of the first has been lessened 
by time, but because, in many instances, the system has never been fully 
brought under the influence of the disease. It is not a little curious, that, 
amongst those in whom vaccination was attempted but failed, the mortality 
was greater than in any other class; for, out of eleven patients so circum- 
stanced, five, or nearly one half, died. 

The admissions during the diflferent seasons of the year were as follows. 

1840. 1841. 1842. 

Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. 































































Total, 31 6 183 34 52 4 

It will be seen by the above table that but few cases occurred in 1840, that 
early in 1841 they rapidly increased, and again gradually diminished in 1842, 
until in the month of August the house was closed. The influence of the 
summer months in diminishing the frequency of the disease is very appa- 
rent. By a reference to the register of deaths for the city, we find the same 
remark holds good, the number of deaths from smallpox during the three 
spring months, viz., March, April, and May, of 1841 being 64, that during 
June, July, and August 51, whilst during the following three it increased 
again to 100. The total number of deaths in the city for this year were 
5833, those from smallpox being 259, or rather less than a 22d part of the 
whole number. 

In the hospital but few young children are admitted, but, by reference to 
the city register, we find that of the 259 deaths above mentioned, 143, or 
considerably more than half, were of the age of five years or under. Of the 
same number 155 were males and 104 females. 

Secondary aff'ections, viz., opthalmia, swelling of the lymphatic glands, 
abscess, erysipelas, internal inflammation, &c., were met with from time to 
time in the hospital cases, but could hardly be considered as frequent, and 
rarely gave rise to serious consequences. Two deaths only could be attri- 
buted to these causes, viz., one from erysipelas, and one from cancrum 
oris, in a child about three years of age. To these, perhaps, should be 
added an individual who died on the 58lh day after admission of sloughing 

84 Slewardson on Smallpox. [Jan. 

ulcer on the back and hip. The exact period after the appearance of the erup- 
tion at which death took place cannot be known from the register, but we 
are perfectly safe in stating that the great majority took place in the course of 
the second or early part of the third week. The comparative freedom from 
secondary or concomitant affections may perhaps in part be attributed to the 
location of the hospital, and its excellent construction for ventilation. 

The treatment employed was very simple, and such as we believe is now 
generally approved of. The daily use of small doses of citrate of potash, an 
opiate at night where there was much restlessness, and an occasional 
cathartic, were all that was necessary, in a large proportion of the cases. 
When the eruption was abundant and did not fill well, weak milk punch 
was freely resorted to at this stage. The punch was rarely made stronger 
than a wine-glassful of brandy to a quart of milk, to be used in the twenty- 
four hours. Of course it was necessary to watch its effects, and occasionally 
its employment might be contra-indicated by the condition of the stomach, 
or other causes, but as a general rule it was clearly beneficial in the cases 
mentioned. When the tongue become dry, the fever considerable, (fee, small 
doses of calomel were sometimes used with advantage, as in other cases of 
fever. Bleeding was scarcely ever resorted to, and indeed the patients were 
rarely brought to the house until after the eruption had made its appearance. 

To relieve the sore throat a gargle of Cayenne pepper was usually 
resorted to, and commonly with good effect. In a few cases, however, it 
seemed to aggravate the inflammation, and gargles of sage tea and alum, &c. 
were substituted. Now and then it was found necessary to apply the pow- 
dered alum directly to the part. Mild lotions, made with the pith of sassa- 
fras, were commonly all-sufficient to control the conjunctival inflammation. 
When more severe, leeching was occasionally resorted to; but upon the 
whole a few drops of a solution of about 4 gr. of nitrate of silver to the ounce 
of water once in the twenty-four hours exerted the most decided control over 
the inflammation. 

In the spring of 1841 I commenced using the mercurial ointment, which 
had been recommended with the view of producing abortion of the pustules 
and preventing cicatrices. The plaster was first applied to a portion of the 
face and of the fore-arm severally of two patients in whom the eruption was 
considerably advanced, probably about the fifth day, but little effect was 
observable. It was next applied to a part of the lower limb of a child about 
four years old on the third day of the eruption, and removed on the sixth, 
when the pocks beneath were found much less developed than elsewhere, and 
some of them absolutely aborted. In another child, similarly circumstanced, 
but little effect was apparent, except over a small part of the leg where the 
plaster had been closely applied, its imperfect application elsewhere being 
probably the cause of the slight influence produced over the rest of the sur- 
face. It was now applied to the forehead and right side of the face of a 
black girl aged 19, in whom the pocks were moderately abundant, on the 

1843.] Stewardson on Smallpox. 85 

third day of eruption, and removed on the eighth, when the pustules beneath 
were found aborted, especially over the cheek, whilst on the opposite side 
they were full and just beginning to turn. The skin here also was tender 
to the touch, which was not the case on the right side; this difference being 
very marked even between the two sides of the nose. Subsequently the 
pock dried away on the right side without forming scabs, whilst the left was 
studded with them. At the time of her discharge, 16 days after the removal 
of the plaster, it was evident that the pustules had left a much deeper impres- 
sion on the left than on the right side, but whether any permanent pits would 
be left may be doubted. 

In a white girl, aged 20, the plaster was affixed to the whole of the fore- 
head and face, on the second day of the eruption, which was pretty abun- 
dant, and removed on the sixth, when" the pustules beneath were found, 
generally, aborted. On the ninth day, when the pustules on the neck and 
breast were full, the cheeks were nearly smooth, and no scabs existed on 
any part of the face except a few on the end of the nose. A week afterwards, 
when discharged, some very small pits were observed on the nose, but 
scarcely any decided pitting elsewhere. 

Having thus satisfied myself that a decided influence was exerted by the 
mercurial plaster upon the development of the pustules when these had not 
advanced beyond the third day, it became important to determine whether 
the same influence would not be exerted by simple ointments, such as lard, 
or simple cerate. For this purpose it was important to institute a comparison 
upon corresponding parts of the same individual, as in this way all sources 
of error, such as those arising from differences of constitution, the form, pro- 
gress, severity, &c., of the disease would be avoided. Indeed it is quite 
clear that a single satisfactory experiment of this kind would be more con- 
clusive than a large number in which different individuals were the subjects 
of comparison. 

Mary Holmes, white, aged 22, unprotected, entered hospital June the 7th. 
Stii. Third day of eruption, which was moderately abundant only, and 
presenting as yet hardly any vesicular appearance on face, a plaster of mer- 
curial ointment was affixed to the left side of the forehead and face, and one 
of lard to the right, and on the following day the simple cerate was substi- 
tuted for the lard. 

iSth. Eighth day of eruption. On right side, where simple cerate was ap- 
plied, the pustules are maturated, opaque, more so than on neck, small as 
elsewhere. On left side, they are generally aborted, or contain very little 
matter. On the ala of nose, &r,c., where the ointment was imperfectly ap- 
plied; a few are maturated but very small. The arrest of development on 
this side gives to it a strikingly different aspect from the opposite. 

lith. On right side, the pustules maturated, opaque, like those on neck 
and breast, the cheek tender to the touch. On left side, maturation very im- 
perfect, none of the pustules opaque except a few about ala of nose, &c., the 

86 Stewardson on Smallpox. [Jan. 

rest being red elevations, with a trace of demi-opaque fluid at the summit; 
cheek not tender to the touch, and can be rubbed without the patient's 

I8th. Thirteenth day. On right side, pustules have not yet dried. On left 
side, some are a little whitish, but contain no fluid except along ala of nose, 
&;c. Some difference as before between the two sides, though less in degree, 
as regards tenderness to the touch. On neck, chest, and arms, some only of 
the pustules are beginning to dry, the fluid which they contain being of a 
very dead white instead of yellow. 

23d. Eighteenth day. Since last note, some of the pustules on left of face 
have come forward a little, but have not maturated and formed green scabs 
as on the opposite side, which has continued sore and been somewhat 
swollen; whilst the left, as before noted, is not tender to touch, and either 
not swollen at all, or decidedly less so than the opposite side. The left 
side of face indeed felt so much more comfortable, that yesterday the patient 
remarked that she wished I had applied the ointment to both sides. To-day 
on right side, the scabs are pretty thick and greenish, there being scarcely 
any on left side, where the pustules present the appearance merely of dead 
white loose epidermis. 

July I9th. Forty-one days after admission, she was discharged cured, the 
pitting on the left side of the face being decided, but the pits smaller than on 
the opposite side. 

The same experiment was tried in the case of a black girl, when the 
eruption was probably about at the 6th day, but still vesicular, and the same 
differences between the two sides were observed, but less in degree; the 
process of maturation on right, when the mercurial ointment was applied, 
being partially arrested only, whilst on the left the pustules were full, and 
the face swelled so as to occasion a striking contrast with the opposite side, 
which was also less tender to the touch. When discharged, the face was 
pretty deeply pitted on both sides. 

From these experiments, it seems pretty evident that the mercurial plaster 
has a decided influence upon the smallpox pustules, preventing more or less 
completely their perfect maturation, and diminishing the concomitant swell- 
ing and soreness, the process of desiccation being completed without the 
formation of thick scabs, and the resulting cicatrices less marked than when 
the process of suppuration was left to pursue its natural course. It is also 
apparent that this influence is chiefly observable in cases where the eruption 
has not advanced beyond the third or fourth day. 

Having satisfied myself of the general fact,, I continued to apply the oint- 
ment in cases where the eruption was abundant, and had not advanced be- 
yond the period mentioned. The application was made by spreading the 
mercurial ointment upon a piece of thick muslin, previously shaped like a 
mask, with apertures for the eyes, nose, and mouth, and extending from the 
ears and roots of the hair to the lower margin of the jaw; and kept in its 
place by strings attached to its posterior margin, and tied across the back of 

1843.] Mott's Nasal Operation. 87 

the head and neck. A separate piece was made for the nose, but notwith- 
standing every precaution, there were certain parts, as the crevice around 
the ala of the nose, its point, &c., which could not be kept in perfect appo- 
sition with the plaster. To avoid this, it is recommended by M. Briquet, 
to smear tlie ointment over tliese parts before applying the mask. The same 
gentleman, I find, recommends that the mask should be several times re- 
moved and spread with fresh ointment, a precaution not often taken in the 
cases which I have treated. Had it been, it is altogether probable that the 
effects would have been still more marked. In some cases the strong mer- 
curial ointment was used, and in others it was rubbed down with an equal 
bulk of lard. It was sometimes difficult to resist the pressing solicitations 
of the patients to have the plaster removed, especially in the summer sea- 
son, when the melting of the oily parts, and the greater moisture of the skin, 
rendered its presence very annoying. The same difficulty, however, is not 
experienced during cooler weather. In one case the mercurial plaster of 
the pharmacopoeias was used, but owing to its stiffness and adhesiveness, 
was found less easy of application, and more uncomfortable than the oint- 
ment. No apprehension I think need arise on the score of the system be- 
coming affected, for scarcely ever were the gums even touched. 

Upon the whole, it seems to me that the use of the mercurial ointment, 
in the manner above described, is decidedly beneficial when early resorted 
to in cases where the eruption is abundant; not merely in lessening the lia- 
bility to cicatrices, but in diminishing the swelling and preventing the 
formation of thick crusts. That by its use pitting maybe entirely prevented, 
or the mortality from smallpox materially lessened, seems to me very 
doubtful, although had all the precautions above mentioned been taken, it is 
not improbable that the effects would have been still more decided. 

Art, V. — A Nasal Operation for the removal of a large tumour filling up 
the entire nostril and extending to the Pharynx. By Valentine 
MoTT, M. D. [With two wood-cuts.] 

When the following operation was announced in the No. of this Journal 
for .January, 1842, I was not aware that any one had operated in a similar 
case. It having been asserted that Professor Syme, of Edinburgh, had 
performed the same operation, I immediately addressed a letter to him on 
the subject, describing my case, and requesting to know if he had met with 
anything like it. He promptly and kindly replied, and states — 

*' You will find a case somewhat similar, in the 9th report of the Edin- 
burgh Surgical Hospital, published in the Edinburgh Medical and Surgical 

88 Mott's Nasal Operation, [Jan. 

Journal for 1832, the 34 ih vol. There is another recorded by Mr. Flau- 
bert, of Rouen, in the Archives Gen. for August, 1840." 

Tliis case, which was published in the Edinburgh Medical and Surgical 
Journal for 1832, is of trifling extent compared with the one we have de- 
scribed. The operator first divided the upper lip to the septum nasi, turned 
the flaps aside and detached the lip from the jaws so as to expose the tu- 
mour without detaching the columna or ala of either side. This he did, " to 
obtain sufficient room for extracting a large fibrous polypus which projected 
both externally and into the pharynx, but did not succeed." He says, 
" afterwards when the symptoms had become much more urgent, I removed 
the superior maxillary bone, as the only means of relieving the patient from 
the disease." 

Rl. Flaubert, of Rouen, in 1840, performed the formidable operation of 
exsecting the superior maxillary bone for a large fibrous polypus of the left 
nostril, extending to the pliarynx. Various attempts to remove this morbid 
mass were made with wires and ligatures, by the operator and his father, 
with partial success only. This patient recovered completely with very 
little deformity.* 

Yesterday I received a small sheet published by Professor Syme, and ex- 
tracted from the London and Edinburgh Monthly Journal, for Sept. 1842, con- 
taining a second operation for nasal polypus. He found this case of a 
malignant character, and after cutting off the projecting portion of the tumour 
the patient was informed that nothing more could be done for his relief, and 
was discharged from the hospital as incurable. No evulsion was at any 
period attempted. 

After a short time the patient returned in consequence of repeated bleed- 
ings from the tumour, and urged for the sake of his family to have some 
operation performed, to give him any chance of having his life preserved. 

Professor Syme says, " I resolved to try what could be done for the poor 
man's relief. An incision was made through the upper lip, from the nostril 
downwards to the mouth, and the flaps were then separated on each side 
from the gum, so as to afford free space for examining the attachment of the 
tumour. It then appeared that the growth proceeded from the septum by 
a narrow neck not larger than a fourpenny piece, immediately above the 
connection of the cartilage to the bone, and that there was consequently no 
difficulty ill completely rooting out the disease. I cut through the septum a 
little way above the lower margin, so as not to interfere with the columna, 
divided the bone with pliers, and separated the remaining cartilaginous at- 
tachments. The surfaces of the wound were then brought together, after 
torsion of the coronary arteries, and retained by stitches of the interrupted 
and twisted suture. In the course of a few days, there was hardly any per- 
ceptible trace of the operation, and the patient has since continued perfectly 

* See Archives Generales de Medecine for August, 1840. 

1843.] Mott's Nasal Operation, 89 

These are the only three cases of this operation, as far as we know, on 
record. Two by Professor Syme, and one by M. Flaubert; they have all 
been successful, and they are all original. In some particulars they are 
similar, and yet they are all different. The bones in all the cases were 
perfectly sound. They are different from what are understood by the upper 
jaw operations as performed by Gensoul and others of Europe, and many 
surgeons of our own country, in which there is disease of the bony struc- 
ture, and generally malignant. The present operation we think ought to be 
denominated the nasal, to distinguish it from the ablation or exsection of the 
upper-jaw for malignant disease of the bone or antrum, or both. 

My operation was performed without the knowledge of either Syme's or 
Flaivbert's, and appears to me to be more extensive than theirs, and is as 

Augustus McBurth, cabinet-maker, aged 32, born in Scoharie county. 
New York, ten years ago felt a stoppage in his left nostril, accompanied 
with a dull aching pain, which was much aggravated on taking cold. About 
one year from the commencement of these symptoms, a tumour made its 
appearance in the nostril of the same side. At first it was of a deep red 
colour; but it gradually assumed a lighter hue, and would occasionally pro- 
ject beyond the anterior opening of the nasal fossse, especially in damp 
weather. At this stage of the disease he came to this city, and placed him- 
self under the care of a surgeon, who made several attempts to remove it by 
forceps; but such was the hemorrhage that accompanied each attempt, that 
it was deemed unsafe to make any further trials to remove it. After remain- 
ing in the city three days, he went to an adjoining state, where several trials 
were made to remove it by means of a ligature; but as each unsuccessful 
effort seemed to impart only fresh vigour to its growth, he determined to 
submit to no further treatment, except to have portions of it removed from 
time to time, when it should become inconvenient from its size. In 1836 
he removed to this city, where parts of it were from time to time removed 
by forceps and ligature, each attempt being attended with much pain and 
hemorrhage. His sufferings had now become so exceedingly acute that for 
one year he could not sleep in the recumbent position. There was a feeling 
of distension conveying the sensation of a wedge forcing forward tlie jaw 
bone. In March, 1841, he gave up his business, and urged by the intensity 
of his sufferings he was induced to submit to one more trial for its removal 
by ligature. The wire was in his nose for 11 days, but no benefit resulted 
from its application. He thinks that from first to last, at least 500 attempts 
were made to remove it, by about 50 practitioners. In June he applied to 
me for relief. 

The tumour anteriorly and posteriorly, was so fi.rm and dense that very 
little impression could be made upon it by forceps when firmly grasped. 
After trying several times to get a wire through the nose about the posterior 
part of the tumour, and getting firm hold of the anterior part with forceps, 


Molt's Nasal Operation. 


and the part below the palate with the vulselhim, without being able to 
make the least impression on it, I determined upon the following operation. 
Having for years been in the habit of recommending a similar one for the 
removal of the inferior turbinated bone, when affected with carcinoma. 
On July Sth, 1841, 1 commenced an incision through the soft parts a little 
Fig. 1. on the side of the mesial line of the in- 

ternal angular process of the os frontis, 
and extended it downwards to the upper 
lip, which was divided about three lines 
from the angle of the mouth. Two flaps 
were then reflected: the inner including 
the cartilaginous parts of the nose, and 
the tissues covering the os nasi of the 
left side; the outer laying bare the bone 
as far as the infra-orbital foramen. The 
anterior part of the tumour was now 
somewhat more distinctly seen, and the 
nasal cavity was farther exposed, by 
sawing vertically through the os nasi, as 
far as the transverse suture, so as to avoid 
the descending plate of the ethmoid. The 
superior maxillary bone was now divided 
in a line from the upper part of this cut 
to a point opposite the second bicuspis 
tooth, and on a lavel with the floor of 
the nostrils. Another section was made 
from the termination of the last, extend- 
ing horizontally inwards towards the 
vomer. The osseous parts comprising 
the OS nasi, a considerable portion of the 
superior maxillary bone, and the os 
spongiosum inferius were then detached. 

T-,. 1 . , . p.. The connections of the tumour were par- 

Fig. 1 gives a good view or the i^ 

direction of the incisions in the soft tially separated; but the disease was so 

^u^% T^^l'v^^^ -""^A^^^ ^T"^ '''^'r extensive, that a part had to be removed 
The dotted lines indicate the course of ' ^ y^ ^^ 

the sawing of the bones. through the anterior opening, before the 

posterior attachments could be liberated. These having been detached, the 
larger portion of this extensive disease, which passed into the pharynx and 
completely plugged up the posterior nares, was removed by introducing 
through the mouth a large curved vulsellum and forceps, and seizing the 
mass as it descended into the pharynx. 

After the operation gave sol. sulph. morph. gtt. x. Evening. — Comfort- 
able and complains of little pain. 

9th. Had slept well, and is much pleased with the freedom of breathing; 


Mott's Nasal Operation. 


no febrile excitement; pulse only 69. Comfortable in every respect, and 
does not complain of soreness of the wound, around which there is but little 
swelling; has taken some chicken broth; bowels not having been moved, 
ordered an enema. 

10^/i. Had slept tolerably well; but at intervals during the night suffered 
considerable pain; some tumefaction of the face to-day, but not more than is 
usually attendant on an operation so severe. No febrile excitement, pulse 
being only 60, but somewhat wiry; free evacuation from the enema last 
evening; another enema ordered; diet light. 

Wth. Passed the night well; feels comfortably; swelling of the face less; 
and complains of nothing but a stoppage of the nostril, caused by a slight 
oozing of blood; pulse 62; bowels have been naturally moved; allowed to 
take any light nutriment. 

\2th. Symptoms as yesterday. 

\^th. Feels comfortable in every way; swelling of face disappearing; 

appetite good; has slept well during the 
night; pulse 64; bowels free. 

\lth. Pulse 64; appearance in all re- 
spects greatly improved; tumefaction of 
the face has very much subsided; re- 
moved the dressings and took away the 
sutures; wound entirely healed by adhe- 
sion, except at the points, where the 
ligatures remain; reapplied short strips 
of adhesive plaster. 

22c/. Removed the plaster and pulled 
away the three ligatures. The patient 
feels desirous to go out, and expresses 
great gratification at his entire freedom 
of breathing, and rapid progress towards 

May 2dth, 1842. There is no ap- 
pearance of any return of the disease, 
and the patient enjoys better health than 
he has done for ten years, and works at 
his trade. 

The accompanying figure (fig. 2) is an 
accurate likeness of the patient, taken from 
the life; and the line of the cicatrix in the 
soft parts as exhibited at the present 
time, July, 1842. 

Fig. 2. 

New York, Oct. 20th, 1842. 

92 Joslin on Meteorology of Hemorrhage. (^Jan. 

Art. VI. — On the Meteorology of Hemorrhage. — By B. F. Joslin, M. D., 

of the City of New York. 

Medical and meteorological studies bear some resemblance to each other 
in the complexity of the subjects and the difficulty of establishing complete 
and comprehensive theories. 

Medical meteorology combines difficulties inherent in both classes of sci- 
ences; and though destined at some future time to be a science of great 
interest and importance, it is at present, and is perhaps for a considerable pe- 
riod longer to be, in a condition wliich may be termed fragmentary. 

In the hope of adding a fragment to those already collected, I have endea- 
voured to examine a limited portion of this extensive field. 

The object here proposed is to examine among the various causes whose 
combined influence determine the time when a spontaneous hemorrhage shall 
occur; whether the condition of the atmosphere has an influence so great 
as to be detected by a careful comparison of medical and meteorological ob- 

In the course of a medical practice of fifteen years, and the daily observa- 
tion and record of meteorological facts during the greater part of this time, 
the writer has become so far convinced of the existence of such an influence, 
as to induce him to undertake the labour of making a numerical estimate for 
obtaining the average results in relation to a considerable number of cases. 

The examination has been restricted to cases of hremoptysis and uterine 
hemorrhage occurring in his own practice, and from lack of time, and the 
great labour required for calculating the mean meteorological results for all 
the months and years up to the present time, those three continuous years 
in which the meteorological observations were more nearly complete, have 
been selected. This period ended in May, 1837. The locality was Schenec- 
tady, New York. 

Of the cases of haemoptysis and uterine hemorrhage scattered through 
these three years, those only have been selected whose date was recorded; 
they amount only to fifty-four. In two or three of the cases selected, there 
may be a slight uncertainty as to the day of attack, but in neaily half of them 
the hour of attack was recorded. 

A few remarks may be indulged in respect to the rules and principles by 
which the estimate was made. 

The selection of cases has been determined solely by the degree of evi- 
dence as to the exact day or hour of attack; and to avoid any bias from pre- 
conceived opinions, the selections have been made j)reviously to consulting 
the meteorological journal. In but one instance has an exacerbation, or an 
attack within two days of a previous attack of the same patient, been in- 

The mean dew-point of each day of attack has been selected as the dew- 

1843.] Joslin on Meteorology of Hemorrhage, 93 

point for the time, and compared with the average for the corresponding 
month. As the changes of season have comparatively little influence on the 
mean monthly atmospheric pressure, the mean height of the barometer for 
the corresponding year has been taken as the standard with which to com- 
pare the height as observed at the hour nearest that of the attack, or, in case 
of uncertainty as to this, the mean height of the day. For times when this 
instrument was exposed to considerable changes of temperature, a correction 
for temperature has been generally made. In regard to rain or snow, where 
either the hour of its occurrence or that of the attack was unknown, there no 
attempt has been made to arrive at the probable fractions of a day. 

No attempt is here made to distinguish between the effects of rain and those 
of snow. Indeed, this distinction for all purposes of medical meteorology, 
is frequently more apparent than real. What falls as rain at the earth's sur- 
face, is frequently the product of melted snow. Meteorologists seem rarely 
to reflect on this fact, but, on the contrary, erroneously attribute the forma- 
tion of snow to the congelation of clouds or of rain. For want of a more 
appropriate word in our language to express the descent either of snow or 
rain, the term storm, or falling weather, will be sometimes employed; and 
those days will, for the sake of brevity, be called stormy days, on any part 
of which rain or snow fell. 

For the purpose of examining the influence of rain and snow, and of the 
barometrical and hygrometrical conditions and changes of the atmosphere, 
the tables have been arranged in fourteen columns. The first shows the 
number of the case and the date of attack; the second column shows the 
number of stormy days immediately preceding each day of attack or com- 
mencement of hemorrhage; the third the number of the days immediately 
succeeding the day of attack; the fourth column the proportion of stormy 
days in the corresponding month, expressed in hundredths, the whole 
number of days in the month being taken as unity; the fifth column the 
number of days (and fractional parts when known) between the commence- 
ment of the hemorrhage and the nearest preceding day, or part of day, of 
storm; sixth, the number of days which elapsed between the time of attack 
and the next succeeding storm. Hence O in both these columns signifies 
that the storm existed at the hour, or at least on the day, of attack. The 
seventh exhibits the condition of the atmospheric pressure on the day, and, 
as near as practicable, on the hour of attack, as compared with the pressure 
twenty-four hours previous. The eighth exhibits the same thing for the time 
of attack; i. €., shows whether the barometer was rising, falling, or sta* 
tionary, according to the evidence afforded by the next succeeding as com- 
pared with the next preceding observation of the same day. In the ninth 
and tenth the barometer is compared with the mean, in terms of hundredths 
of an inch, above or below. The eleventh column exhibits the dew-point on 
the day of attack; the twelfth the mean dew-point of the month; the thir- 
teenth the difference between the dew-point and temperature of the air for 
No. IX.— January, 1843. 7 

94 Joslin on Meteorology of Hemorrhage. [Jan. 

the day, and the fourteenth the same for the month. All the columns 'are 
complete except those for dew-point, which could not be conveniently 
obtained for the colder months. This has been given for thirty-three cases. 
The first table exhibits the results for uterine hemorrhage, and the second 
for haemoptysis. 

Results. Season and temperature. In examining the results let us first 
inquire the influence of season. The months in which the greatest number 
of cases occurred were June and September, haemoptysis taking the lead in 
the former, and uterine hemorrhages in the latter. It would seem that neither 
the extreme of heat nor that of cold is among the most influential causes. 
"Whether change of temperature at the time has an influence, is a different 
inquiry; and by examining the dew-point, and the difference between it and 
the temperature, it is seen that some depression of temperature is a usual 
concomitant of hemorrhage. The average depression of the thermometer 
below the monthly mean was 3°, but the fall was greater for haemoptysis. 

The hygrometrical state of the air may be next examined; first, in rela- 
tion to the dew-point, which affords a measure of the absolute quantity of 
contained vapour; and secondly, in relation to the difference between the 
dew'point and temperature, which aflfords a measure of the degree of damp- 
ness, in other words the degree of approximation to the point of precipita- 

Now the average dew-point for the whole collection of cases is about 3° 
below that of the corresponding months. The air then, at the earth's sur- 
face, contained less than the usual amount of vapour. We are not to con- 
clude that the air possessed a more desiccating quality; for the average dif- 
ference between the dew-point and temperature (taking into account the 
relative number of the two kinds of cases) differed but one-tenth of a degree 
from the monthly mean. The average dampness for each class of hemor- 
rhage was near the usual standard, but was rather greater for hsemoptysis. 
As the average dampness for both classes collectively was almost exacdy the 
same as that for the corresponding months, there is no evidence that damp- 
ness per se has any influence on hemorrhage. As to the absolute height of 
the dew-point, there was a close agreement between the two classes, each 
giving (within one-third of a degree) a difference of 3° from and below that 
of the month. Here then, there is something which appears to be conducive 
to hemorrhage in general; but when we recollect that there was a correspond- 
ing depression of temperature, which leaves the dampness unchanged, and 
also that great cold has of itself little predisposing influence, we become, in 
the present stage of the inquiry, restricted to the conclusion, that that atmo- 
spheric agency, which conduces mainly to hemorrhage, is neither dryness 
nor humidity, nor heat nor cold, but some change or condition — whatever it 
be — which, on an average, is attended by a reduction of temperature and 
such a corresponding diminution of vapour as leaves the degree of humidity 
nearly unchanged. 

1843.] Joslin on Meteorology of Hemorrhage.' 95 

Atmospheric pressure next claims attention, being, like temperature and 
humidity, one of the less complicated phenomena, and the subject of instru- 
mental measurement. 

The barometrical results were more remarkable than the thermometrical 
or hygrometrical ones, and very different in some respects from what gene- 
rally received opinions would lead us to anticipate. 

If we regard the average changes of pressure during the twenty-four hours 
preceding the time of attack, we find nothing remarkable, unless it be a re- 
markable want of influence, shown by a strict conformity to what the theory 
of probabilities would require for the average results of accidents in a numer- 
ous collection of cases. In other words, the instances in which the barome- 
ter was rising were nearly equal to those in which it was falling; and this 
correspondence extended to both tables. Before the ut&rine hemorrhages, 
the barometer was rising 13 and falling 14 times; and before haemoptysis, 
the proportion was also 13 to 14. This shows, if any thing, a slight tend- 
ency to depression, but not sufficient to justify any general conclusion for 
this number of cases. 

The case is different for the days of attack. On those the barometer was 
generally falling, and in a greater proportion of instances than could, with 
any probability, be attributed to accident. Out of 54 cases, it was in 35 
falling at the time of attack, in 18 rising, and in 1 stationary. 

Hence the probability that the atmospheric pressure shall be diminishing 
rather than increasing at the time of an attack, is about as two to one. A 
confirmation of the opinion that the barometer will generally be found fall- 
ing at or near the commencement of a hemorrhage, is found in the fact that 
the proportion was almost exacdy the same for both classes of hemorrhage, 
being 17 to 9 for the uterine, and 18 to 9 for the pulmonary. It is difficult 
to believe that this falling of the barometer was accidental, when the propor- 
tion was so great and so nearly correspondent for both kinds of hemor- 

If this great influence of a diminution of atmospheric pressure be me- 
chanical, we should be inclined, ci priori, to anticipate that the effect would 
be at the maximum when the pressure was at a minimum, and the blood 
vessels in an unusual degree deprived of this external and mechanical 

But it is interesting to notice, that the facts exhibited in another column 
contradict such a conclusion. The barometer, though generally falling, is 
not low, but on an average about one-third of a tenth of an inch above the 
mean height for the year. That the existence of some excess above the 
mean was not the accidental result of a moderate number of cases, appears 
probable from the fact that the two classes of hemorrhage differed in this 
respect from each other, only about one-fourth part as much as one of them 
differed from the general average of the year. 

Instead of the number of times above and below, the average height has 

96 Joslin on Meteorology of Hemorrhage, [Jan. 

been selected, as being less liable to vitiation by errors as to the exact 
time of attack, or the exact barometrical heights, whether mean or par- 

If we select those cases which are unexceptional as to reliance on small 
difTerences, for example, those whose exact hour of commencement was 
known, and was between sunrise and 10 o'clock, P. M., between which 
times the barometer was consulted, we find it to have averaged about one 
and a half tenths above the mean, for each class of hemorrhages, and for 
each to have been two or three times as often above the mean as below it» 
The range was from only a twentieth of an inch below, to more than a third 
of an inch above. 

From all the barometrical facts we may draw the conclusion, that at the 
commencement of hsemoptysis or uterine hemorrhage, the barometer is 
generally fallings and from some points above the mean. There would 
seem to be, in general, some influence predisposing to hemorrhage, between 
the time of maximum and medium height, for that section of the month in 
which the attack occurs. 

Falling vjeather remains to be examined. A storm of rain or snow is a 
complex phenomenon, and involves changes in those more elementary ones 
which have hitherto engaged our attention. It is generally preceded — fre- 
quently at an interval of some days — by an increase of atmospheric pressure, 
and a diminution of the dew-point; but, as the storm approaches, ail these 
usually approach the mean, and pass to the other side before or after its com- 
mencement. It will be perceived that the state of things, so far as examined, 
which gives the hemorrhagic tendency, seems usually to agree with some 
part of this transition period. 

Let us see how far this conclusion conforms to the observations on the 
times of hemorrhages and storms. 

In the first place, the average time to the nearest preceding day of falling 
weather exceeded that to the nearest succeeding day; and, if we exclude the 
storms which occurred on the days of the hemorrhage, the average distance 
between the nearest past and future storms was about three-fourths of a day; 
the difference being, however, greater for uterine hemorrhages. The mean 
results at the feet of the tabular columns are deduced by including the stormy 
days on which hemorrhages occurred, which gives a less absolute distance, 
but the same disproportion between the distances to past and future storms; 
the ratio being as 35 to 26, for both classes of hemorrhages collectively. 
The disproportion is seen to be less for haemoptysis than uterine hemorrhage, 
but the balance decidedly on the same side. 

We see the same tendency by examining, in a different way, the number 
of times in which the nearest storm occurred after the uterine hemorrhage 
was to that in which it occurred previously, as 10 to 2. The proportion for 
haemoptysis was 12 to 7, and for the hemorrhages generally as 22 to 9. 
The disproportion between the intervals to the past and future storms would 

1843.] Joslin on Meteorology of Hemorrhage, 97 

have been found still greater, and the above ratios also nearer to each other, 
had we excluded from the estimate those storms which were three or more 
days distant, and which on that account may be presumed not to have ex- 
erted a sensible influence. 

These facts tend to the conclusion, that atmospheric condition of the period 
preceding a storm is more conducive to hemorrhage than that which imme- 
diately succeeds one. 

A confirmation of this conclusion is found by comparing the three days 
which immediately precede the hemorrhage with the three which immedi- 
ately succeed it. For the proportion of the former, which were stormy, was, 
for both kinds of hemorrhage collectively, only 36^ per cent., that of the 
latter 51 f. The disproportion was greater for the uterine and less for the 
jmlmonary, but still the balance was on the same side.* 

Moreover, the hemorrhages usually occurred at the conclusion of several 
days which had presented less than the usual amount of falling weather. 
The proportion of days of rain and snow for the corresponding years was 
44 per cent., for the corresponding months 45 per cent., and for the three- 
day periods preceding the hemorrhages 863 per cent.; for the three days 
preceding uterine hemorrhages 33, and for the three days succeeding them 
59 per cent. Thus it was eminently the case with uterine hemorrhages, that 
they were preceded by an unusual amount of dry andya^r, and succeeded by 
an unusual amount o^ foul, weather, the succeeding and preceding stormy 
days being to each other nearly as two to one. 

We may conclude then, first, that the time of an attack of haemoptysis 
or uterine hemorrhage is usually farther removed from the nearest preceding 
days of falling weather than from the nearest succeeding ones. It may be 
expressed by saying, that the attack is oftener before a storm than after a 
storm. Secondly. The stormy days which precede the hemorrhage are 
usually less numerous than those which succeed it, and indeed less nume- 
rous than for the same length of time in other parts of the corresponding 
month. Both these remarks are more strikingly exemplified in cases of ute- 
rine than in those of pulmonary hemorrhage. 

On reviewing all the meteorological circumstances, we see the mean re- 
sults, whether barometrical, thermometrical, or hygrometrical, all conspiring 
to point to a time of transition from a fair and dry, to a more foul and 
stormy period, or at least to a time characterised by great electrical changes, 
and especially to the development of much free electricity in the upper re- 
gions of the atmosphere, by the precipitation and even crystallisation of 
aqueous vapour. That an electrical, or what may even be termed, in many 
cases at least, a magnetic influence, and one which operates at a distance, is 
one of the most influential of the morbific agencies concerned in the above 
results, I am strongly inclined to believe. 

* The separate results may be seen in columns second and third of table J. and II. 


Joslin on Meteorology of Hemorrhage, 


As the stages of disease and various internal and external circumstances 
must contribute to determine the precise time of an attack of hemorrhage, 
the scientific physician will not be surprised at the want of correspondence 
between the meteorological and medical results in many particular instances, 
but will be led by the former considerations to admit the reality and appre- 
ciate the importance of atmospheric agencies which, in spite of all other 
disturbing influences, still manifest themselves in the average results. 

Table I. — Uterine Hemorrhage. i 


c 1 









Time of attack. 



._ O 





witti the 








.S be 


.B M 



















May 29, A.M. 










June 8, 11 A.M. 














October 11, 










Nov. 6, morning, 









December 23, 










April 2, 








July 7, 














September 12, p. m. 











September 30, 














October 5, 












October 14, 












November 9, 










Novem. 11, 3 a. m. 







Novem. 14, 9. p. m. 








Decern. 4, evening, 








December 11, 










January 15, 4 p. m. 







February 6, 










February 13, p. m. 







April 5, 












September 9, 3 p. m. 











Sept. 9, early a. m. 












Septem. 22, 2 p. m. 











Sep 28, 29, midnight 














October 10, 9 p. m. 














October 29, 











February 5, 







Averages, - - 






F. 14 









R. 9 

*^ a 

S. 1 



Joslin on Meteorology of Hemorrhage, 
Table II. — Haemoptysis, 





Time of attack. 






S ^ 
a S 






.2 "an 



Barometer in pre- 
ceding twenty-four 








I the 


















1 May 20, 










2 June 13, 











3 June 18, 











4 June 19, 











5 June 23, 













6 June 28, early a.m. 

71 March 4, 











.2 9 






&;May 1, 









9 May 4, 






10iJune25,3A. M. 



.5 3 










Ill September 18, 

12' April 7, 























13 June 24, noon. 











14' June 27, 5 p. m. 













15 July la P.M. 
























17 July 23, 2i A.M. 













18 Sept. 29, 3 a. m. 













19; Sept. 30, 10 p.m. 













20 October 7, 











October 9, 10 p.m. 














October 10, 6i A.M. 














November 2, 7 a. m. 







Novem. 27, 9 a. m. 









25 February 9, 









26 February 10, 9 p. M. 










April 30, 7 a. m. 







Averages, - - 







R. 9 








Art. VII. — Plastic Operations. By J. Pancoast, M. D., Professor of 
Anatomy in Jefferson Medical College. Lecturer on Clinical Surgery at 
the Philadelphia Hospital. 

In the last No. of this Journal I offered some general observations in refer- 
ence to the different methods employed in Plastic Surgery for the recon- 
struction of lost parts, and related some cases illustrative of their application 
to the restoration of the Nose. I shall now detail the results of some opera- 
tions exhibiting the further application of the principles involved in those 
processes, to the restoration of lost portions of the external Ear, of the Eye- 
lids, and Lips. 

Otoplasty. — The art of restoring portions of the external ear, is as old as 
that of the re-formation of the nose. No attempt has perhaps ever been 
made to re-construct an ear entire, and it is very questionable if the trial was 
made, that it could, from the peculiar formation of the organ, be attended 


Pancoasi's Plastic Operations. 


with any satisfactory success. Where the destruction of parts is limited to 
the pinna or lobus, there is a base left for the engraftinent of flaps. Under 
such circumstances the operation has been attended with success. The 
only form of plastic operation applicable here, is the Indian, the flap being 
taken from the neighbourhood of the mastoid process or from the front por- 
tion of the temporal bone. This mode was practised by Taliacotius himself, of 
w^hich drawings are given in his work De Curt. Chirurg. per Institutionem. 
Case. — Sarah J. Morris, residing at No. 8 Jay street, a patient preparing 
to have a new nose made after the Italian method, brought to-day, July 26, 
1842, to the cUnique of the Jefl^erson Medical College, her son, aetat. 8, the 
left side of whose face had been deformed by an extensive burn, three years 
ago. The lobe and tragus of the ear, and the skin covering the ramus and 
part of the base of the jaw were involved in a common cicatrix. The 
pinna was drawn close to the head, and the lobe from the destruction of the 
skin on its posterior surface, was lost in the common covering of the face 
and neck. The operation was performed before the class as follows: 

A piece of integument somewhat larger than the natural size of the lobe, 

was marked out with the scalpel in 
front, as seen in the cut. rA. semi- 
circular portion of larger size, but 
narrowed where it touched the pos- 
terior part of the cicatrix, was dis- 
sected up from over the insertion of 
the sterno-cleido-mastoid muscle. A 
sharp pointed bistoury was then 
passed under the front portion, so as 
to raise it with a single sweep of the 

Fi£. 15. 

instrument. The everted edge of the 
tragus was then loosened with the 
knife, the raw surface below, which 
was of considerable size, bled freely 
from two small arteries, that did 
not, however, require ligatures. The 
margins of the wound were brought 
together with two hare-lip sutures 
and a strip of adhesive plaster. The 
posterior flap was then brought round in front, under the anterior, and the 
edges fastened together with two stitches of the interrupted suture. The 
parts then presented a good appearance; the lobe being made larger than 
was natural to admit of the shrinking which must necessarily follow. The 
lower part of the ear which had been strained downwards by the cicatrix, 
retracted when loosened by the steps of the operation, to very nearly the 
natural length. 

July 29th. The pin and sutures were removed. Union had taken place 
by first intention but to a small extent on the side of the neck. Partial 

1843.] Pancoast's Plastic Operations. 101 

union had occurred between the flaps of the new formed lobe. The parts 
were dressed with adhesive plaster. And now, Aug. 11th, have almost 
entirely closed. The lobe is a little tumid, but well shaped, and the ear 
presents an appearance but litde different from that of the opposite side.* 

Blepharoplasty , — The restoration of an eyelid which has been partially 
lost, or the entire reconstruction of a new one, is required under the follow- 
ing circumstances. 

\st. In extremely bad cases of ectropion, the consequence of a wound or 
ulceration of the integuments; or of a cicatrix, following an extensive de- 
struction of the skin and its subjacent tissues from scrofulous ulceration, 
carbuncles, or erysipelas; where the ciliary margin of the lid and the tarsal 
cartilage have not been destroyed, but so drawn off from the orbit, as to 
leave the eyeball exposed, and the everted fungous palpebral conjunctiva 
strained over the margin of the bone occupying the ordinary position of 
the skin. This destruction of tissue and eversion of the mucous mem- 
brane, may be partial, as when the cicatrix is formed on the side of the 
temple, or it may extend to the whole lid, as usually occurs when there has 
been an extensive destruction of integument, over the eyebrow, or malar 
bone. In some instances, the deformity has been seen to exist in both lids 
of one eye at the same time. In cases of this description, beyond the pros- 
pect of cure by the usual operation for ectropion, a plastic process, modified 
to suit the necessities of each particular case, may be practised with success 
by the surgeon. 

2f?. In cases where there has been a loss of the whole substance of the 
lid — skin, muscles, cilia, and cartilage, and in consequence the eyeball 
left exposed and liable to destruction by inflammation. The lid must be sup- 
plied entire, in instances of this sort, by transferring in front of the ball a 
portion of the surrounding integuments, by one of the three principal plastic 
processes already described in the preceding number. We may diminish by 
this means the deformity, protect and save the eye; but it is impossible to give 
a mere transplanted flap of skin the numerous ofiices of a natural eyelid. If 
it be the upper lid that has been restored, it must of course be immovable, 
a mere membranous curtain hung in front of the ball. If it be the lower, 
in which there is usually but little movement, the operation will be far more 

Case I. — Rachel Morris, a coloured woman, eetat. 33, had suffered when 
20 years old, with a scrofulous affection of the glands of the neck, which 
was attended with subcutaneous abscess, and extensive ulceration of the 
integuments in front of the right ear. She recovered with a rugous mottled 
cicatrix, extending from the upper part of the concha of the ear to the base 
of the jaw, and from the outer can thus of the eye to the upper extremity of 

* Under the judicious management of Dr. Charles Huston, the ear by the 1st of Sep. 
tennbcr, was brought into so good a shape, as not to be distinguit^hed in that respect from 
the other. 


Pancoast's Plastic Operations, 


the sterno-cleido mastoid-muscle. The ulcerated surface closed, as in a 
burn, with a great retraction of the healthy skinT The external canthus was 
drawn outwards and downwards; the upper lid was shortened and held 
nearly immovable over more than the upper half of the orbit. The under lid 
was drawn outwards and downwards, so that the external two-thirds of its 
mucous covering rendered rough and fungous by the exposure, was strained 
over the margin of the orbit, so as to become the covering to the malar bone. 
The internal third of the lid was thrown forward upon the cheek, by the 
diseased and thickened roll of conjunctiva behind it. There was a constant 
discharge of the lachrymal fluid mixed with pus. The cornea, from expo- 
sure, had become hazy, so as to render vision in this eye imperfect; and the 
patient, unable to get employment as a house-servant, had come into the 
hospital for relief. March 5th, 1839, I restored the lid before the hospital 
class, to its proper position, by the following operation: 

The V incision of Sir Wm. Adams, was made as seen in the cut, through 
Fig, 16. the substance of the lid. 

The rounded and pro- 
tuberant conjunctiva was 
removed with the hook 
and scissors, up to the 
inner canthus of the eye. 
The lower lid was loos- 
ened from its morbid 
attachment to the mar- 
gin of the orbit, and an 
attempt made as in ordi- 
jnary tarsoraphy to bring 
the divided edges of the 
lid together. This could 
not be accomplished in 
consequence of the ex- 
treme degree of tension 
with which the integu- 
ments had been drawn downwards by the cicatrix. Two crescentic incisions 
were then made, each about three quarters of an inch long, from the lower 
apex of the division of the lids; one sweeping upwards and forwards towards 
the eyebrow, the other downwards and forwards toward the nostril. The 
triangular portions of skin and subcutaneous tissue, were loosened with a 
few strokes of the scalpel, the upper lid pushed up to its proper level, and 
the two flaps drawn upwards and forwards upon the ball of the eye, and 
fastened together with two of Dieffenbach's sutures. The lid was completely 
restored. The elliptical wound which was left was nearly closed by a hare- 
lip pin, and a strip of adhesive plaster. A compress and bandage were ap- 
plied over the eye, and kept wetted with cold water. 

On the third day the wound was dressed and the pins removed. There 


Pancoast's Plastic Operations, 


was a good deal of tumefaction of the lid, and some suppuration from its 
free surface. The upper pin of the lid, and the pin upon the side of the 
temple, had partially cut out. Nevertheless union had taken place, by first 
intention, over about half the elliptical wound, and rather more than half the 
divided edge of the lid. By the use of adhesive straps, mild astringent lo- 
tions, and a gende compressing bandage, the cure was complete in sixteen 
days. The lid retained its position, and was perfectly natural in appearance, 
with the exception of a slight tendency to eversion at the outer canthus, caused 
by the failure to procure union by first intention in the elliptical wound, and 
the contraction which necessarily followed its cicatrization.* 

Case II. — J. P. Jr., a bookseller, in Third street above Noble, aetat. 45, 
was affected with grangrenous erysipelas of the left side of the face, in 
June, 1840. A large portion of the integuments in front of the malar bone 
was destroyed. He was judiciously treated by Dr. Charles Noble of this 
city; but it was found impossible, as cicatrization of the extensive ulcer 
took place, to prevent the drawing down of the lower eyelid, so that its 
mucous membrane took the Fi^. 17. 

place of the skin, covering the 
lower margin of the orbit. The 
cut represents well the appear- 
ance of the parts. The lower 
part of the eyeball was left un- 
covered. The upper lid for the 
protection of the ball, was held 
down lower than on the oppo- 
site side; the ocular conjunctiva 
was red and tumid, and though 
the cornea was uninjured, the 
eye was so irritable that he was 
compelled to keep it covered 
with a shade. A hw cilia were yet remaining along the margin of the 
everted conjunctiva, which was continually covered with a puruloid secretion. 

May 29th, 1841. With the assistance of Dr. Brooks, of Wheeling, and Dr. 
Moehring, of this city, I proceeded to the following operation: — The ordi- 
nary V incision was made, as seen in the cut, with the base resting upon the 
ciliary margin of the deformed lid. The rounded hardened fold of conjunc- 
tiva next the ball of the eye was removed with the forceps and scissors; the 
lid on each side of the excised portion separated from the margin of the or- 
bit with a few strokes of the scalpel. An attempt was now made to raise 
the lid to its proper position, and bring the sides of the V incision together 
with the hare-lip suture. The tension of the cicatrix below was too great to 
admit this. A curved incision was then made through the skin, nearly concen- 
tric with the orbit. Two incisions that met below were dropped from near 

* I am indebted to my friend, Dr. Perry, of Georgia, then resident surgeon, for the notes 
of this case. 


Pancoast's Plastic Operations. 


Fig. 18. 

the outer end of the curved one, so as to include a triangular piece of integu- 
ment, which was dissected up 
and removed, as in DiefTenbach's 
operation. Two hare-lip sutures 
were made across this triangle, 
as seen in Fig. 18. As the sides 
of the triangle were brought to- 
gether by the closure of the su- 
tures, the margin of the lid above 
was at once raised up to its pro- 
per level. The two twisted su- 
tures employed in the tarsoraphy 
were now closed, with the effect 
of turning the free edge of the 
lid in contact with the ball of the 
eye, and completely removing 
the deformity. Considerable 
blood flowed during the operation. A compress and bandage was applied 
over the parts, and the patient confined to a dark room; lead-water and lauda- 
num was applied to the eye. On the second day some erysipelatous inflam- 
mation followed; the patient was freely purged with calomel and black 
draught, and the astringent application persevered in, the proportion of the 
acetate of lead being raised to ten grains to the ounce. On the third day 
the pins were removed. The erysipelatous inflammation, which had consi- 
derably subsided, had served to prevent complete union by the first intention. 
It had taken place, however, at the bottom of the triangle, and at the lower 
half of the wound of the lid: the parts retained their position. The bread 

Fig. 19. 

poultice of Abernethy 
was laid over the parts 
till the tumefaction 
subsided; this took 
place at the end of 
forty-eight hours. — 
Adliesive strips were 
then applied to the lid 
and cheek, and a ban- 
dage and compress 
used to keep the lid 
turned upon the ball. 
In two weeks all was 
healed. The wound 
on the free margin of 
\ the lid closed up per- 
\ fectly, but so as to 

1843.] Pancoast's Plastie Operations. 105 

leave a slight break or depression. During the cicatrization of the wound of 
the cheek, the lid was drawn down, so as to be a little, but very little, lower 
than that of the opposite side; but it was in close contact with the ball; the 
tears found their way by their natural channel, the eye completely recovered 
its strength, the patient was freed from all inconvenience, and retained but a 
trace of his previous great deformity. Fig. 19 is a faithful representation of 
the appearance of the lid, the drawing having been taken more than a year 
after the operation. 

Cheiloplasty . — The restoration of the lips when they have been in part or 
wholly lost, has been brought to a surprising degree of perfection within a 
few years past. It is not long since a loss of substance, sufficiently great to 
prevent the use of the common hare-lip suture, was thought to be beyond the 
resources of the art. Now there is scarcely any loss of substance, however 
hideous, of the mouth and lips, that cannot be remedied by the skill and in- 
genuity of modern surgeons. 

Nearly all the forms of plastic operations have been applied in turn upon 
this region. Each has its application to particular kinds of deformity, and 
almost every new case that presents itself, has in it something peculiar, so as 
to require a particular exercise of the surgeon's ingenuity. 

The different processes applied to the lip may be classed under four heads. 
1st. The French method. — If the loss of substance is not very extensive, 
after the usual incision in V is made to pare off the edges of the cicatrised 
fissure, or for the removal of cancer if that is the cause of operation, the 
lamen on each side is to be dissected from the maxillary bone, till both, by 
gentle stretching, can be brought up in contact and secured with the twisted 
suture. This is always to be preferred when it will suffice without straining 
the lip too much inwards upon the teeth. But where the loss of substance 
is great, various modifications of this process are employed. In that of Cho- 
part, two vertical and parallel incisions were dropped down from the ends of 
the V to the two ends of the base of the os hyoides. The intervening lamen 
was dissected from the jaw, down as far as the os hyoides, drawn up to the 
proper height, squared at its free surface, and fastened by the twisted suture 
to the sides of the remaining portions of the lips. Roux of St. Maximum 
modified this process by loosening the remains of the lip from the jaw bone, 
and continuing the dissection down to near the os hyoides, then stretching the 
integument loosened subcutaneously, like an apron, up to the proper level, 
flexing the head upon the neck at the same time. To facilitate this dissec- 
tion in Roux's method, Lisfranc and Morgan have directed the integument to 
be divided in the median line, which is subsequently to be united by suture 
when the new lip is raised to its proper level. In the plans both of Chopart 
and Roux, the head must be held by bandages flexed upon the chest during 
the process of union, an inconvenient and painful position, and the difficulty 
which exists of maintaining it without motion, must necessarily be very liable 
to cause a failure in the operation. 


Pancoast's Plastic Operations. 


The 2d process is that of tlie filling up of the breach in the lip by a trans- 
plantation of skin taken from the arm, as repeatedly performed by Taliaco- 
tius on the upper and lower lip; or a flap may be taken from the neck, as 
practised by Mr. Liston, the skin being dissected up, with a pedicle of at- 
tachment below the chin, and then twisted round and fastened by suture to 
the freshened margin of the lower lip. Besides other inconveniences result- 
ing from this operation, the new lip thus made is thin and membranous, and 
remains so pale and withered, as to be neither sightly or serviceable. 

3d Process. — For this we are indebted to the boldness and ingenuity of 
M. Dieffenbach. Its object is to reconstruct a thick and serviceable lip, con- 
sisting of skin, mucous membrane, aud intervening muscular tissue. 

Upon the first and last of these processes only can the surgeon with any 
certainty rely for the restoration of a useful and well-formed lip. On the 
first, as suited to cases where the deficiency is not extreme; and on the third, 
when the loss comprises a large portion, or even the whole, of the lower lip. 
And the latter, in which there seems such free division of the cheeks, is not 
by any means so painful or protracted but that it can readily be borne. 
These two processes will be illustrated by the following cases. 

Abraham , setat. 40, was severely injured by the explosion of a 

cannon while in the act of ramming down the cartridge, on the 4th of July, 
1836. His left arm was shattered, the left eye destroyed, the upper lip ex- 
tensively cut, the lower lip violently contused and lacerated, and all the front 
teeth and sockets dislodged from the lower jaw bone. His arm was ampu- 
tated, and he recovered well with the exception of the lower lip, of which 
there was so much loss of substance as to leave a deep gap to the left of the 
median line, as seen in the cut. Through this the saliva constantly drib- 
bled, the tongue protruded, and in consequence his articulation was so indis- 
tinct as to be scarcely intelligible. 

Fig. 20. Nov. 1839. I operated in the Phi- 

ladelphia Hospital for the removal of 
the deformity before the class. It 
was impossible to adjust the lips by 
the common hare-lip process. I re- 
moved, in a V shaped piece, the 
rounded edges of the cicatrix. Then* 
from four lines above the apex of 
the V, which was on a level with 
the lower surface of the jaw bone, I 
made two curved incisions in the di- 
rection of the extremities of the base 
of the OS hyoides. The lips and in- 
teguments were next freely separated 
with the knife from the lower max- 
illa. The flaps were then rotated 
a little upwards, drawn inwards* 


Pancoast's Plastic Operations, 

and united to each other on the middle line by two twisted sutures. The 
sliding of the flaps inwards and upwards brought near together the sides 
of the incisions below the chin. A couple of strips of adhesive plaster 
beneath the chin sufficed to close them. A compress covered with cerate 
and a few turns of the bandage for fractured jaw completed the dressing. 
Fig. 20 will serve to explain the plan of the operation. On the third day 
the first pin was removed, and the remaining one on the following day. 
One week from the day of operation he was discharged cured. The cica- 
trices were little apparent. The lip was well formed and full, with the 
exception of a slight break, made by the pressure of one of the teeth of the 
upper jaw.* 

Case VITI. — Miss Ann N. cetat. 20, a young lady from Virginia, entered 
the Philadelphia Hospital, Dec. 18, 1840, anxious for the removal of a de- 
formity caused by gangrene of the lower lip when she was between two and 
three years old. Her health was good, her complexion rosy, and the upper 
part of her face exceedingly well shaped. The region of the lower jaw, 
seemingly from want of development, presented the appearance usual to per- 
sons of extreme age. This is tolerably well shown in the profile view, 
fig. 21. All the front teeth, with their Fig. 21. 

alveolar processes, had been removed 
between the molars of the two sides, 
and the jaw itself reduced to a narrow 
plate in front, where it was covered 
with nothing but closely adhering in- 
tegument, discoloured and wrinkled, 
presenting much the appearance of a 
cicatrix following a burn. The whole 
lower lip had been destroyed; the de- 
struction had even extended beyond 
the commissures of the mouth on each 
side, though it was greatest in the 

The resistance having been removed 
below, the levator anguli muscles had raised the corners of the mouth, giving 
an undue fulness to the cheeks unpleasantly contrasting with the chin. From 
the dense adhesion of cicatrix to the jaw the mouth could only be opened to 
a small extent, and when closed the chin moved up too far, and fell in com- 
pletely within the range of the upper teeth, which were large and prominent. 
From the shortness of the jaw the apex of the tongue protruded through the 
opening, the saliva constantly flowed from the mouth, so as to compel her to 

* For the notes of this case I am indebted to Dr. M'Pheeters, one of the resident sur- 
geons of the hospital. 


Pancoast's Plastic Operations. 


keep it commonly covered with a bandage, and her articulation was almost 
unintelligible to those not familiar with it. 

Fig. 22. The mouth is represented in its usual 

state in fig. 22.* 

Of the two plans which appeared to me 
feasible for the cure of this hideous de- 
formity — the French method, and that of 
DiefFenbach, the former was resolved on 'as 
being the least hazardous and severe, and 
which, if it failed to remove the deformity 
entirely, would, in all probability, diminish 
it so as to facilitate the cure by the latter 
process. The operation was performed 
very much as described in the preceding 
case, before the hospital class. In addition 
the commissures of the mouth were divided 
in order to give more breadth to the line for 
the formation of the lower lip. From the 
extensiveness of the cicatrised surface I was 
compelled to pass the pins through tissue that was not healthy in structure. 
From the same cause the parts that were brought together were so dense 
and unyielding as to make great tension upon the two upper pins. To re- 
lieve this, two incisions after the manner of Celsus were carried downwards 
from the corners of the mouth. Muscular tissue as well as integument were 
divided in the cut. This effected, to a considerable extent, the object desired. 
Nothing unusual occurred during the treatment of the case, except some 
hemorrhage on the fourth day from the right commissure, which was readily 
suppressed by the resident surgeon with a little powdered gum arable and 
dry lint. On the third and fourth days the pins were removed. The upper 
pin had nearly cut out. Union by first intention had only taken place be- 
neath the lower pin. The parts above were swollen and constantly mois- 
tened with saliva. Strips of adhesive plaster and elm bark poultices 
were applied, and from time to time the suppurating edges were touched 
with a zinc solution. Some further union of the parts occurred by granu- 
lation, and cicatrization took place, with a marked diminution of the fissure 
below, and a much greater fulness of the side portions of the lip, and with- 
out any impairment of the patient's health. The deformity, however, was 
still great. The patient, from the improvement which she already per- 
ceived had taken place, was anxious for the second step of the operation. 
This was undertaken, sufficient time having elapsed to allow the thickness 
and stifiTness of the parts to subside resulting from the former operation. 
Second operatio7i. — The patient was as before seated upright in a chair. 

* For the drawings from which these cuts have been made I am indebted to the pencil 
of Mr. R. A. Street. 


Pancoast's Plastic Operations. 



The cjorne;'s of the mouth v/ere thrown widely open by an incision on each 
side three-fourths of an inch long, in the direction of the auditory meatus. 
A sharp-pointed curved bistoury was passed, for that purpose, through the 
cheek from the cavity of the mouth, and its whole thickness divided on each 
side at one cut to the commissure. From the distal ends of these incisions 
a descending cut was made on either side, with a single sweep of the bis- 
toury, obliquely downwards and inwards to the top of the lower jaw bone. 
Two flaps were thus detached of the whole thickness of the cheeks, lined with 
skin on one surface, and mucous membrane on the other, and hanging from 
the chin by a pedicle five-eighths of an inch broad. The flow of blood was 
arrested in a measure on each side, as the division was made, by the thumb 
and finger of an assistant. In order to diminish the hemorrhage the hori- 
zontal and descending incisions were made on one side before the other was 
touched, and the divided vessels immediately secured by torsion and liga- 
ture. The flaps were then rapidly loosened from the gum on the inside, by 
a few strokes with the knife, and some few small arteries, which gave out 
blood, pinched and twisted. The loosened portions were then rocked over 

their inner margins met on 
Fig. 23. 


upon their pedicles towards each other, till 
middle line, where they were secured with 
three hare-lip sutures. The traction of the 
flaps caused the portion of the cheek in 
connection witli the outer margin of the 
pedicle to advanco forwards, so as to sup- 
ply in part the place they occupied previ- 
ous to their change of position. An irre- 
gular triangular opening was still left at 
the corners of the mouth. This was filled 
up by drawing the cheek from above down- 
wards and forwards, and passing, on each 
side, 'two hare-lip pins, to connect the 
three sides of the triangle together. 
Though as much stress was put on the 
ligatures as was thought at all prudent, the 
orifice could not be completely closed, a 
small, triangular, fistulous orifice remain- 
ing. The immediate effect, in regard to the improvement of the features, 
was magical, and is well shown in fig. 23. The flaps of the new lip, which, 
as they were rocked inwards moved forwards in the direction of the line of 
their pedicular attachment, gave all the natural fulness and prominence to 
tlie lower lip. The descent of the protuberant cheeks restored, in a great 
degree, the natural roundness of the lower part of the face; and, from a disa- 
greeable, the patient presented at once a comely countenance. 

The operation, which was one of some magnitude,'and somewhat protracted, 
was borne courageously by the patient; considerable blood was lost, and 
No. IX.~January, 1843. 8 

110 ' Pancoasfs Plastic Operations. [Jan. 

though slie was seated in a chair, much annoyance resulted from its passing 
into the throat. The parts were supported with a compress and bandage, 
and my usual dressing of lead-water and laudanum applied. The patient 
was kept under the soothing and sustaining influence of opium, gtt. xx. acet. 
opii being given by enema every four or six hours, according to the impres- 
sion made on the system. Iced gruel was allowed for drink. She passed 
the following night very comfortably; little feverish excitement followed the 
operation. There was some discharge of blood into the mouth, which 
lodged there and became offensive. An increased flow of saliva followed, and 
dribbled out of the small unclosed openings at the corners of the mouth, and 
over the place of junction of the flaps in the middle line. This occurrence 
presents an obstacle to union by first inteniion, and makes operations on the 
lower lip far more difficult of management than analogous ones on the upper. 
The usual therapeutic treatment was employed, which it is not necessary here 
to particularise. On the third day the lower pin of the lip was removed; union 
had taken place here by first intention. On the fourth the middle pin was 
removed, as well as the upper, which was cutting out. No union had taken 
place below these pins, but the parts not being disposed to separate far, 
though swoln and everted, were easily held together by adhesive plaster; a 
solution of sulphate of zinc, to give tone to the swollen edges, and excite 
granulations, was applied. On the fifth day the pins were removed from the 
corners of the mouth; union by first intention had partially taken place here. 
An opening which would admit the end of the little finger existed, and 
through this there was a discharge of offensive bloody serum; but no sphace- 
lation had anywhere occurred, except at the upper part of the left flap, 
where the pin had nearly cut out. The patient's health remained good. Nu- 
tritious broth and mulled eggs were allowed her for diet. The parts were well 
cleansed, washed with sulphate of zinc, and supported with adhesive plaster, 
and a few turns of a roller. On the sixth day the former treatment was con- 
tinued, with the addition of an emollient poultice, to favour the growth of 
granulations; and by increasing gradually the strength of the zinc wash up 
to ten grains to the ounce, by the tenth day the middle line of the lip had 
closed completely, though the free edge of the lip was a little irregular. The 
corners of the mouth were not completely closed till the thirteenth day, and 
then by a growth of granulations which caused at this point a puckering of 
the cheek. 

To remove the depression left by the cutting out of the pin, which caused 
the irregular line of the new lip, the apex was touched twice a day with a 
solution of arg. nitrat., gradually increased in strength, in order to close it 
up by forming a growth of granulations. This object was in part accom- 
plished, but the margins of the depressions becoming cicatrised, they were 
shaved off with the bistoury, and the sides of the depression approximated 
with strips of adhesive plaster. This accomplished the object desired, and the 
lip was reconstructed perfecfly, full, thick, high, with a red margin, and 


Pancoasl's Plastic Operations. 


level on the surface, with the exception of a little tuberculated prominence 
on the side, which was subsequently removed. The new lip projected about 
half an inch above the upper edge of the gum, but was everywhere adhe- 
rent to the front surface of the gum and the maxillary bone, and consequently, 
though partly made up of the muscular tissue of the cheek, immobile. Al- 
lowing time to elapse, till all the inflammatory changes of the parts had 
disappeared, I separated with a scalpel the new lip from the gum and jaw, 
for the double purpose of rendering it mobile and removing tlie tension and 
depression at the angles of the mouth; this I believed would be effected by 
allowing the muscles of the cheeks to stretch it upon the sides, so as to re- 
move the depression. Both objects were almost perfectly accomplished, and 
the patient was discharged from treatment, highly delighted with her im- 
proved appearance, the face being perfecdy natural in profile, with a well- 
formed lip, which not only obstructed the flow of the saliva, prevented the 
protrusion of the tongue, but enabled her to articulate with much more and 
increasing distinctness: the only obvious peculiarity about the face being 
the cicatrix, and some remaining slight depression at the corner of the mouth. 
This, it is believed, will disappear in time; the hardened tissue around the 
cicatrix will become softer and more extensible, and the seam of junction, if 
it does not entirely disappear, will diminish in size, so that at a subsequent 
period it may be cut out with the knife, and the parts reunited by first inten- 
tion, leaving nothing more than a common cicatrix like that following a 
simple incision. The patient was three months in the hospital, though a 
great part of the time was con- 
sumed in allowing the necessary 
time to elapse between the first and 
second operation, so as to admit of 
practising the latter to the best ad- 
vantage. This operation for re- 
supplying the whole substance be- 
tween the mouth and chin, is one of 
very considerable difficulty, and re- 
quires a much greater exercise of 
skill, address, and ingenuity, than 
any plastic operation I have at- 
tempted, even that of the formation 
of a new nose. No one can appre- 
ciate the difficulties who has not 
made the trial. But the success 
in this case was gratifying to a de- 
gree, more than commensurate to 
the difficulty and delay involved in 
the case, as it restored an interest- 
ing young female to society with 

Fifr. 24. 

112 Reckon the Signs of Pregnancy. [Jan. 

scarcely a single remnant of her deformity to attract a stranger's attention. 
Fig. 24 represents well the features of Miss N., and was taken six months 
after the last operation. The new lip is movable, though not to the natural 
extent; the cicatrix on the cheek is now but little apparent, and her articula- 
tion, though a little thick, perfectly intelligible. I know not that this form 
of operation for the lip has been before performed by any other surgeon than 
Dieffenbach; but I am disposed to believe it, in cases demanding it, entitled 
to the high encomium which Zeis has bestowed upon it in his work on Plastic 

Art. VIII. — On the Signs of PregnoMcy. By T. Romeyn Beck, M. D., 
Professor of Materia Medica in the Albany Medical College. 

The Signs of Pregnancy have been repeatedly noticed by different wri- 
ters during the last and present years, and a condensed analysis of the prin- 
cipal facts, or rather novelties, mentioned by them, may be of some use, as 
well in posting itp the information afforded, as showing how far we are to 
rely on the indications that have been proposed. Among the more elaborate 
papers to which I shall refer, are Lectures on the Signs of Pregnancy, by M. 
Dubois, published in the Gazette des Hopitaux, and a paper by James 
Stark, M. D. in the Edinburgh Medical and SurgicalJournal for January 
1842, on the signs of pregnancy during the earlier months of gestation, and 
on the existence of a new animal principle in the urine during that state. 
This last writer confines his remarks to tlie signs of pregnancy during the 
first three months. 

1. Peculiar Sensations in the Breasts. — "In almost every case, shortly 
after impregnation, peculiar sensations are experienced in the breasts. These 
have been generally described as a sensation of creeping or formication, with 
a fulness and heat in the interior, and an itching over the surface." Dr. 
Stark iidds, that he has frequently been mformed by those who have borne 
several children, that this was the sign by which they were first made 
aware of another pregnancy, and that it occurred before the suppression of 
the menstrual discharge. 

2. Suppression of the Menses. — Dr. Stark is of opinion, that, in some 
instances, the menstrual discharge continues for a few months after impreg- 
nation, while in others it does so during almost the whole of pregnancy. In 
two cases seen by him he has no doubt that the discharge was natural, and 
not to be distinguished from the true menstrual flux. *' In one case, a scrofu- 

* For the notes of this case, and most essential aid in its management, 1 am indebted 
to ray friend Dr. Ludlow, one of the resident hospital surgeons. 

1843.] Beck on the Signs of Pregnancy. 113 

lous woman, with red hair and fair skin, it continued always for the first 
three months after impregnation, and I witnessed this fact during three preg- 
nancies. In the other case, the discharge was just as regular for seven, 
months, when it stopped, but returned immediately on delivery. This woman 
was very swarthy, with black hair and eyes, and it occurred during two 
pregnancies. 1 have also seen coloured discharges attending the progress of 
pregnancy, but never was able to discover that they observed periodical re- 
turns." The reviewer of Professors Hamilton and Davis's works on mid- 
wifery in the same number of the Edinburgh Journal, although professing 
the greatest respect for the opinions of Hamilton, (who denied the possibility 
of menstruation during pregnancy,) arrives at a similar conclusion. *' We 
believe, with Dr. Hamilton, that there never was, strictly speaking, such an 
occurrence, knowing as we do, that the true menstrual secretion proceeds 
from the interior of the uterus and Fallopian tubes, but we also know, that 
many cases have been recorded, on the most respectable authority, where a 
discharge much resembling the menstrual secretion continued during the 
whole of pregnancy, and more especially during the earlier months, which 
is an uncommon occurrence, and also that there are several cases on record 
where that function (menstruation) was alone performed when the females 
were pregnant." 

"As pupils of the late Dr. Hamilton, we were deeply impressed with the 
truth of his convictions. But we were not long in practice before evidences 
so indisputable occurred, that it was impossible to withhold our belief that 
menstruation may occur during pregnancy." 

3. Breasts. — Areola. — Almost immediately after conception the breasts 
enlarge, the glandular structure becomes developed, and one or more of the 
glandular lobules may be felt, hard, enlarged, and painful on pressure. The 
whole of these glandular lobules are not equally affected in d. first pregnancy ; 
in general two or three only in each breast. About the middle or end of the 
second month these hardened lobules become softened, and the breast pre- 
sents a more uniform resistance to the hand. During the third month it 
gradually enlarges and milk begins to be secreted. 

In women who have borne many children, and whose breasts remain 
flaccid, the only change observable at this period is, that the hardness of the 
lobular structure has disappeared, and that, though the breast remains soft 
and flaccid, milk may be drawn from the nipple (Stark). As to the changes 
in the nipple and areola^ Dr. Stark concurs mainly in the correctness of those 
enumerated by Dr. Montgomery. The glandular follicles around the nipple 
become enlarged during the first month; but in a first pregnancy they are not 
found, presenting all their usual characters, until towards the end of the 
second month. They then assume, sometimes a paler, and sometimes a 
redder hue than the surrounding skin. 

The change of colour in the areola commences at the end of six weeks, if 
the female be of a dark complexion, with dark hair and eyes; and the period 

114 'Beckon the Signs of Pregnancy, [Jan. 

is later, according to the fairness of the skin. In all it is quite distjnct by the 
end of the third month, but in neither is the tint so deep as after the fourth 
month (or the next menstrual period). These remarks apply only to a first 
pregnancy. In a woman who has borne children the areola, once produced, 
never entirely fades as long as she is capable of procreating. The glandular 
follicles, once enlarged, never completely disappear; and these, with the red- 
dish white shining network of lines, form a union of signs which are pro- 
duced by no known disease, and indicate unequivocally that the female has 
once been pregnant. 

In a female who has had children and again become pregnant, the glandu- 
lar follicles assume their enlarged appearance at the end of the first month. 
The areola also changes its colour nearly a month sooner, depending, how- 
ever, somewhat on the nature of the complexion. 

As to the objection urged by some observers, that the dark coloured areola 
may be present during certain diseases, and particularly of the uterus, while 
pregnancy is wanting. Dr. Stark remarks, that he has met with only three 
cases of this description, and here, although the coloured areola and nipple 
were present, yet there was no turgescence of the nipple, the areola was dry 
and wrnikled, and the glandular follicles were not enlarged. Lastly, he 
states, that, in some instances of pregnancy, there is an entire absence of all 
colour from the areola. In two cases then under his care, this was the fact, 
but all the other characters were well developed. 

Such is Dr. Stark's testimony. The Edinburgh reviewer, whom we have 
already quoted, (vol. 57, p. 201,) distrusts the infallibility of most of these 
appearances. Dr. Hamilton placed great reliance on the turgescence of the 
areolar ring, yet, in a case quoted by the reviewer, this was actually pre- 
sent, with a dark areola, but no enlarged glandular follicles^ and the patient 
proved not to be pregnant. She was indeed menstruating at this very time. 
The observations of Dubois are equally, if not more distrusting. The dis- 
coloration of the areola is often wanting in females of the fair complexion, 
and again it may be present, without impregnation. "When the turgescence 
occurs, he fully agrees with Hamilton in deeming it a sure sign, but, unfor- 
tunately, in his experience it is rare, not having observed it in more than 
one case out of twenty. Lastly, the enlargement of the glandular follicles, so 
much relied upon by Montgomery, occurs but seldom, and he suggests that 
the subjects seen so frequently by the physician of Berlin (as he styles him) 
must have had some peculiarities which are not observed among the French. 
He even adds, that it occurs in females not pregnant, and is therefore dis- 
posed not to depend on any of these appearances taken separately. 

4. Abdominal Enlargement. — This occurs very shortly after conception, 
and is then owing not to any increase in the size of the uterus, but to the 
sympathy of the stomach and bowels with that organ. This is manifested 
by nausea, vomiting and flatulent eructations, together with a windy disten- 
sion of the bowels. It is rarely wanting during the first two months of 

1843.] 'Beck on the Signs of Pregnancy, " 115 

pregnancy; but while the abdomen is thus tumid, there is also a peculiar 
flatness over the anterior, and what would otherwise be, the most prominent 
part of the swelling. *' This peculiar flat tumidity of the abdomen, is most 
observable during the first two months; and in general, after this period, dis- 
appears to such an extent as to make it doubtful if the person be pregnant." 
About the middle, and certainly at the end of the third month, a fulness at 
the lower part of the abdomen becomes manifest. (Stark.) 

5. Stfj^te of the Uterus. — " During the first two months, the volume of the 
uterus gradually increases; its body becomes somewhat rounded and in- 
clined backwards, whilst its neck approaches nearer to the vulva, and comes 
more within the reach of the fingers." This is Orfila's description, and it 
corresponds with the observations of Dr. Stark. He also denies that the 
uterus actually descends into the pelvis during the first months. The sink- 
ing is only apparent, and has been correctly ascribed by Madame La Cha- 
pelle, to the increase in size of the fundus, which is as yet prevented from 
rising out of the pelvis. 

Dr. Rigby, (Midwifery, American edition, p. 40,) suggests that the soft 
feel of the portio vaginalis of the cervix uteri, is one of the earliest signs. In 
the unimpregnated state, it is hard and almost cartilaginous to the feel. 
From pregnancy, it becomes softer and larger. 

According to Dubois, the gradual obliteration of the neck of the uterus, 
so constantly mentioned by authors, is not invariable. P. Dubois examined 
the body of a female who died in the eighth month; and the neck was found 
as long as it is usually in the first month. Indeed it sometimes preserves 
its length throughout the whole period of gestation. A female presented 
herself at the Clinique in the last stage. P. Dubois found the neck but lit- 
tle shortened, and hence pronounced her wrong in her statement. Labour 
pains, however, soon came on, and these rapidly diminished the length of 
the neck, and were shortly followed by delivery. 

6. Motion of the Fwtus, Quickening. — The earliest period at which this 
is felt, is the eleventh week. If a female asserts its earlier occurrence, she 
has been deceived. Dubois corroborates the statement, that it is sometimes 
not experienced throughout the whole term of gestation. This sign is, how- 
ever, of little value in medico-legal cases. A suspected female will hardly 
speak of it while on examination; various diseases have been mistaken for 
pregnancy. (Dubois.) 

7. Lividity of the Vagina. — This sign, which was brought into notice by 
Duchatelet, on the authority of Jacquemin, has attracted considerable atten- 
tion. Dubois has never been able to satisfy himself of its value; but he can- 
didly adds that his opportunities have not been similar to those of Jacque- 
min. He doubts whether it is an exclusive sign of pregnancy. It may be 
seen with a speculum immediately after the cessation of the menses; and 
again, it may be caused by several diseases. Dr. Malvani, on the other 
hand, at the meeting of the Scientific Congress, held at Turin in September, 

116 Beck on the Signs of Pregnane^/. [Jan. 

1840, stated that he had found this lividity to be a constant attendant not 
only of pregnancy, but of the puerperal state. His situation as attending 
physician to a hospital containing females labouring under the venereal, 
gave him many opportunities of verifying the frequent occurrence of the 
sign. In some it was not very manifest, until after the second month of 
pregnancy. — {Archives dela Mededne Beige, vol. iv, p. 216.) 

8. Auscultation. During the first ten weeks after conception, Dr. Stark 
has never been able to detect the placental souffle, but he has noticed it in 
the beginning of the eleventh, and very distinctly in every case that he has 
examined, towards the end of the twelfth week. This corresponds with 
the observations of Kennedy, although contrary to those of Montgomery 
and Velpeau. (Stark.) 

According to Dubois, this sound is dependent on the circulation in the 
vascular tissue of the uterus. He therefore objects to the term in use, and 
prefers that of the uterine souffle. Consequently, he asserts that it changes 
its situation. Its intensity also is variable, being more marked on some 
days than on others; and during labour, it is enfeebled or suspended by the 
contractions of the uterus. It is ordinarily first observed during the four- 
teenth or fifteenth week, although it may be noticed earlier, should the fun- 
dus rise previous to that, above the upper brim of the pelvis. 

Valuable as this sign is in early announcing the presence of pregnancy, 
Dubois is still not disposed to consider it an infallible one; but asserts that 
it occurs in cases where fibrous tumours are present in the cavity of the 
uterus, unaccompanied by pregnancy. The fcBtus also may die during 
gestation, and the uterine souffle continue. The reader will observe that 
these statements necessarily follow as deductions from the cause assigned by 
our authors. On the action of the foetal heart, {doubles hattemens,) he re- 
lies much more strongly as a sign. He adds, however, nothing new to its 

9. State of the Urine. — (A) Donne announced to the Academy of Sci- 
ences at Paris, in May 1841, that he had ascertained from a great number of 
experiments, that the urine of pregnant women contains much less uric acid, 
phosphate and sulphate of lime, than that of others not pregnant. (See 
America?! Journal of Medical Sciences, N. S., vol. iii. p. 218.) The in- 
ference is, that part of the calcareous salts commonly found in the urine, is 
required for the formation of the bones of the foetus. M. Lubanski confirms 
this by his own experience. He sent the urine of a female, in whom neither 
the touch nor auscultation afforded any proof to Donne. The peculiarity 
was present, and in about a month afterwards the patient miscarried of an 
embryo of apparently the third month. In another instance Donne examined 
the urine of a female for a totally diflferent object. He found the usual quan- 
tity of precipitate. A short time afterwards, repeating his experiments upon 
another specimen, he discovered a notable diminution in the precipitate. 
From this he suspected pregnancy, and the result justified his suspicions, for 

1843.] Bgc\ on the Signs of Pregnancy, 117 

she had an abortion three months afterwards. "All authors," says M. Lu- 
banski, " who have written on embryology, consider ossification as taking 
place on the fifteenth or thirtieth day after conception. This new forma- 
tion of osseous parts can only occur at the expense of the mother. It is 
therefore quite logical to endeavour to ascertain whether the calcareous salts 
of the urine of the mother are diminished." — Annales D^Obstetrique, quo- 
ted in the London and Edinburgh Monthly Journal of Medical Science, 
vol. ii. p. 206. 

(B) Kiesteine. The number of this journal for July last, [American Jour- 
nal of Medical Sciences, N. S., vol. iv. p. 13,) contains an interesting and val- 
uable paper on this sign by Dr. Elisha K. Kane. The reader will find in it 
the resuhs obtained by Nauche, Eguisier, and Golding Bird, followed by the 
observations of Dr. Kane on a greater number of cases than were noticed 
by all the preceding physicians. The whole paper deserves a careful peru- 
sal, and I will refer to only a few points particularly bearing on legal medi- 
cine. Out of 85 pregnant females whose urine was examined, he obtained 
a well marked kiesteine pellicle in 68; in 1 1 it was observed in a modified 
form, while in 6 it was wanting. Of these last, two were labouring under 
severe diseases. The cheesy odour was noticed in 7 cases only. Kiesteine 
was detected in one case by Dr. Kane as early as the fourth week, and in 
another before the fifth, while in several it was present before the end of the 
third month. 

Having thus unequivocally proved its presence during pregnancy, Dr. 
Kane next proceeds to inquire whether it can be deemed diagnostic of that 
state, and peculiar to it. Without being aware of the results obtained by 
Mr. Letheby, {American Journal of Medical Sciences, N. S., vol. iv. p. 
223), he confirms them in a striking manner. Out of 94 females in a state 
of lactation, 42 presented no indication of it, 8 a scum imperfectly modified, 
and 44 the perfect pellicle. This last occurred most frequently between the 
period immediately after delivery, and the free discharge of milk from the 
breasts. So, also, it was found when suckling was temporarily interrupted 
by local obstructions; and also of the above number 8 out of 10 females ex- 
hibited it at the period of iveaning. The inference of Dr. Kane would thus 
appear to be well founded, viz., the kiesteine is not peculiar to pregnancy, 
but that it may occur whenever the lacteal elements are secreted, without a 
free discharge from the breasts. 

In a few instances of advanced phthisis he observed a pellicle bearing 
some resemblance to kiesteine. Out of 30 cases, 4 were of this description. 
It is, however, much slower in forming than the pellicle of pregnancy. That 
occurs within a day or two. 

Dr. Stark has also frequently noticed kiesteine during pregnancy, yet oc- 
casionally it was wanting, and particularly in the later months. He has ob- 
served it quite distinct at six weeks after conception. 

I add, in conclusion, the following dsicordant results by (apparently) Ita- 

118 Beck on the Signs of Pregnancy. " [Jan. 

lian physicians. Turchetti has repeated and varied Dr. Bird's experiments, 
and arrives at the following conclusions: — Kiesleine is found in the urine of 
non-pregnant as well as in that of pregnant women; it exists in women la- 
bouring under inflammatory complaints as well as in those in good health; 
it is seen both before and after puberty; it has in all cases the odour of cas- 
eine, but this is stronger in the urine of females who have reached the age of 
puberty; it is seen sometimes in females who are nursing, and lastly, it is 
never seen in the urine of men. 

Dr. Cenni, on the other hand, has never found the kiesteine fully formed 
before the fourth day, and this applies equally to non-pregnant and to pregnant 
women. Its existence is not constant, and to find it, the urine must be kept 
either in a hot or a cold place. He also found it in the urine of men, but 
here it does not cover the lahole surface. It has rarely, either in men or 
women, the odour of caseine. — VExaminateur Medicate, Oct. 3, 1841, 
quoted in the London and Edinburgh Monthly Journal of Medical Sci- 
ence, Dec. 1841. 

(C) Gravidine. When the urine of a pregnant woman is allowed to 
stand for some time, it deposites a copious sediment of a white colour, and 
this is made within a much shorter time during the first four months of 
pregnancy than after that period. On collecting it. Dr. Stark was unable to 
detect the presence of either albumen or caseine in it by the ordinary tests, 
and yet he ascertained that if milk was added to the urine in considerable 
quantity, its caseine could be detected by acids. He also found that this pe- 
culiar matter could be completely removed from the other ingredients by agi- 
tating a portion of the urine with ether. After satisfying himself by a series 
of experiments that this sediment, thus separated, was not identical with 
either albumen, caseine, fibrine, or gelatine, he considers himself warranted 
in considering it as a new principle, to which he proposes the name o^ gravi- 
dine, both from its occurring during pregnancy, and its falling to the bottom 
of the vessel. 

Dr. Griffith, of London, is the only writer, so far as I am aware, that has 
particularly noticed the observations of Dr. Stark. He denies the existence 
of this principle, and asserts that there is in the urine of pregnant women a 
large number of globules, while the deposit consists of lithate of ammonia. 
To the union of these perfectly distinct substances, and Dr. Stark's experi- 
ments on them. Dr. Griffith ascribes the results obtained. Both are insolu- 
ble in ether, but remain suspended in it by agitation. If the sediment be 
boiled in water, and filtered while hot, the lithate of ammonia will be ob- 
tained perfectly pure, and the globules can be washed off the filter. Dr. G. 
also endeavours to show, from the account of Dr, Stark's experiments, that 
the tests used by the latter gave the characteristic results of lithate of am- 

I may add that Dr. G., who informs us that he has for some time devoted 
himself to an examination of the urine in pregnancy, states that he has con- 

1843.] Taylor on Sore Mouth of Nursing Women, 119 

stantly observed the caseous odour, so much so, indeed, that he considers it 
almost as characteristic as the kiesteine. "I think," he adds, "we can fully 
account for Mr. Letheby's getting a putrefactive odour, instead of the case- 
ous, as he uses too high a temperature." — London and Edinburgh Monthly 
Journal of Medical Science, July, 1842. 

On a review of the observations now collected together, it may appear to 
the superficial reader that a great uncertainty still exists concerning the signs 
of pregnancy. But let it be recollected, that most of those which have been 
noticed, occur in the earlier stages, precisely the period when doubts should 
always be entertained in medico-legal cases. The value of auscultation is, 
however, more and more appreciated, and, at advanced periods, actual exami- 
nation of the parts seldom fails to indicate their real condition. The other 
signs are valuable as important accessory ones. 

Cases like the following are scattered through the annals of criminal juris- 
prudence, and they teach but one lesson. "During the French Revolution, 
a young French countess was imprisoned on suspicion of carrying on a trea- 
sonable correspondence with her husband, an emigrant. She was condemned, 
but declared herself pregrj^ant; two of the best mid wives in Paris were or- 
dered to examine her, and they declared that she was not pregnant. She 
was accordingly guillotined, and her body taken to the School of Anatomy, 
where it was opened by Baudelocque, who found twins in the fifth month of 
pregnancy."— 7?i^6?/'s Midwifery, p. 98. 

Art. IX. — Remarks on a Species of Sore Mouth peculiar to Nursing 
Women. By B. Waller Taylor, M. D., of Monticello, Florida. 

This disease, so far as I know, has never been noticed in any of the syste- 
matic works of the day, on the diseases incident to women; nor, indeed, has 
it been described at all until the year 1830, when Dr. E. Hale, Jr. published 
an interesting account of it in the Medical Communications of the Massa- 
chusetts Medical Society, which was copied in this Journal for April, 1842. 
In the number of this journal for January, 1841, we have the next account of 
this disease by Dr. Fred. F. Backus, of Rochester, New York, who states 
that he has met with many cases of this aflTection every year, during a practice 
of twenty-four years. Lastly Dr. Shanks, of Memphis, Tenn., has recently 
informed the editor of this journal that few nursing women of that town es- 
cape it, and in the No. for Oct. last he has given an account of the disease as 
it occurs in that city and neighbourhood. Having met with several interesting 
cases of this singular form of disease during the last year, and believing it to 
be an affection, which, from its importance and novelty, merits an investiga- 
tion, I am, therefore, induced to communicate a few observations relative to it. 

120 TdL-yXox on Sore Mouth of Nursing Women. [Jan. 

Why it has not been noticed until of late years, is a very singular circum- 
stance connected with the history of this disease; for we must suppose that 
lactation had the same sympathetic influence upon the mouth in ancient, as in 
modern times. That it is peculiar to women who give suck cannot be denied. 
Dr. Backus, after a practice of twenty-four years, statjes that it is peculiar to 
nursing women; that " no man ever has had it, or ever will." Dr. Hale, 
Jr. also confirms this statement. In an extensive practice of seven years, I 
have never met with a single case of sore mouth in men, or in women who 
did not give suck, which was in the least analogous to the species of sore 
mouth now under consideration. Why it should be peculiar to women during 
lactation we cannot say, unless we refer the cause to a sympathetic connec- 
tion, sui generis, which exists in certain anormal states of the system, be- 
tween the mammae during secretion, and the mucous membrane of the mouth 
and tongue. As a proof that it is caused by a peculiar influence of the 
mammae, during secretion, upon the mouth and tongue, it will disappear 
rapidly as soon as the secretion is stopped, by M^eaning the child. It ap- 
pears then, that under the influence of the secretion in the mammae, the 
mucous membrane of the mouth and tongue becomes, in some instances, 
sore and inflamed; and that, inasmuch as this secretion does not in every 
case produce this peculiar influence, there must be a co-operation on the 
part either of some organ, or a group of organs, or of the whole system, in 
an anormal state, in order to promote and produce this peculiar influence of 
the mammae, during secretion, upon the mouth. What this anormal state 
of a certain part of the animal economy is, which so acts upon and modifies 
the secretion in the mammas, as to favour and promote the developement of 
this disease, we are unable to determine. We can only say, that as the 
bowels are invariably more or less costive in the earlier stages of this disease, 
we may infer that the peculiar sympathetic influence of the mammEB, during 
lactation, upon the mouth, is connected in some way with derangement of the 
digestive organs. That the cause of this sympathetic influence of the mam- 
mae upon the mouth, cannot be referred to the specific operation of climate, 
or to an epidemic constitution of the atmosphere, is manifest from the fact 
that it is not confined to any particular climate, having occurred to our know- 
ledge in New York, New England, in the West, and in Florida, and that it 
is always sporadic, never epidemic. Women of all classes and of all tem- 
peraments appear to be equally subject to it. The cases that I have met 
with in Florida, though perfecfly well marked, have been so few and scat- 
tering that I think it is comparatively a rare disease. When it does occur, 
however, it is one attended with a great deal of pain and inconvenience, and 
not unfrequently with danger. 

Symptoms. The first symptom is a sensation of soreness and heat of the 
tongue, and lining membrane of the mouth, accompanied by a free discharge 
of a thin watery fluid, mixed with an increased secretion of saliva, which in 
gi few days, as the soreness increases, becomes very profuse. The patient 

1843.] Taylor on Sore Mouth of Nursing Women. 121 

compares the pain and heat of the mouth to the sensation produced by scald- 
ing. After the disease has progressed for a few days, the lining membrane 
of the mouth and the tongue exhibits, upon an examination, a peculiar red, 
or deep pink colour, (as is truly stated by Dr. Backus,) and appears to be 
much inflamed; the edges and tip of the tongue become slightly ulcerated, 
being covered with small white pustules closely connected together, and in 
some instances the ulcerations appear upon the lining membrane of the 
mouth and fauces; and occasionally, if not properly managed, the inflamma- 
tion and ulceration will extend through the pharynx and oesophagus to the 
stomach and bowels — these are the cases that terminate fatally. In the cases 
I have seen, the ulceration of the edges and tip of the tongue did not exhibit 
such a tendency, to extend deep in the substance of the tongue, as the cases 
which Dr. E. Hale Jr. describes; but on the contrary the ulcers were 
superficial. The tongue is uniformly free from fur, and singularly clean, 
having a smooth and polished appearance. This condition of the tongue, 
its red or deep pink colour, and the thin, copious, and watery discharge, 
constitute the chief peculiarities of the disease. The bowels are more or 
less costive, except in those cases in which the inflammation extends from 
the mouth and fauces to the bowels, giving rise to diarrhoea. There is 
usually a good appetite; but in consequence of the soreness and pain of the 
mouth, the patient is obliged to use thin fluid nourishment, of the most 
soothing character, and the blandest mucilaginous drinks; otherwise the 
pain would be most excruciating. The patient is always clear of fever, but 
the irritation attendant upon the disease, loss of rest from the pain and con- 
stant drivelling of the saliva, and the inability to take much nourishment in 
consequence of the soreness of the mouth, all combine in producing great 
emaciation, in many instances. During the whole course of the disease, the 
secretion of milk is abundant, and the child keeps vigorous and healthy. 

Treatment. After having tried various tonics, vegetable and mineral, and 
laxatives, with only partial success, I have found that equal parts of the 
flowers of sulphur and cream of tartar, administered in broken doses, two or 
three times a day, so as to keep the bowels in a soluble state, constitute the 
best treatment as regards internal remedies. The combination of sulphur 
and cream of tartar appears to have almost a specific influence over this dis- 
ease. The best external application, I think, is borax, either in the form of 
solution sweetened with honey or loaf sugar, or finely pulverized with an 
equal quantity of loaf sugar, and applied in the same manner as advised by 
Dr. Dewees, in cases of aphthas in children, only in larger quantity. I have 
also derived great benefit from a weak solution of nitrate of silver, as a wash. 
In cases attended with considerable exhaustion of the system, the sulphur 
and cream of tartar should be only used to the extent of obviating costive- 
ness, if it exist; and tonics, such as the precipitated carb. of iron, and the 
compound tincture or infusion of cinchona, combined with elixir of vitriol, 
should be given in well regulated doses. Porter is also a good and useful 

122 Peebles' case of Calculus in .Appendix Vermiformis. [Jan. 

tonic in such cases. Should the case be complicated by diarrhoea, the diet 
should be bland and farinaceous, as arrowroot gruel, rice gruel, &c,; and 
the drinks mucilaginous, and an anodyne, as a dose of the sol. acet. morph. 
or of laudanum, should be given, and repeated pro re nata. In cases that 
prove refractory, it will become necessary to wean the child, and then a 
speedy cure will be enjoyed. 

MoNTicELLo, Florida, October 1st, 1842. 

Art. X. — Case of death from extensive Intestinal and Peritoneal In- 
flammation, residfing from a perforation of the Intestinal Coats, occa- 
sioned by a Cahxdus lodged in the Appendix Vermiformis. By J. F. 
Peebles, M. D., Petersburg, Virginia. 

At four o'clock, the morning of Sept. 4th, the present year, I was sum- 
moned in great haste to visit Thomas T. C r, a journeyman potter, 

aged 52 years. On entering the apartment, his intensely anxious counte- 
nance, and shrunken features, at once announced to me that I had not been 
aroused so early unnecessarily. The patient was almost wild with agony. 
His pain was seated in the right iliac region, a little below the ileo-colic 
valve, and from thence it darted intensely down the penis to the orifice of 
the urethra, and along the rectum to the anus. I found his skin shrunken 
and cool, yet bathed in perspiration, his pulse small and quick, his tongue 
dry, and coated with a thick yellow crust. His thirst was very great, and 
his stomach was becoming irritable. His abdomen was not unusually tense, 
and no where was there the least tenderness on pressure, except over the 
seat of the pain, where he could not endure the slightest touch. He had 
s'ept well during the night, and only awoke half an hour before my arrival. 
He was, at the moment of waking, conscious of a feeling of great sickness 
and prostration, and before a person beside him in bed, to whom he had 
spoken for the purpose, could strike a light, these feelings suddenly subsided, 
to be replaced by the pain. 

On inquiring into the history of the attack, I learned that on the Friday pre- 
vious, when he returned at evening from the pottery, he had expressed him- 
self as feeling unusually bad. To use his words, he had, during the day tried 
alternately both shade and sunshine, to see if he could not free himself from 
his unaccountably strange and uneasy feelings. He ate his supper however 
as usual, and it was only when he had fallen asleep on the sofa afterwards, 
that his landlady, from his breathing, perceived that he was indisposed. 
His fever continued to rise, and at bed-time he took twelve grains of calomel. 
By the morning the fever had subsided in a great degree, and after taking a 
purgative of castor oil and spirits of turpentine, he dressed himself and walked 
out. At 9 A.M. he was seized with rigor, followed by high reaction, and 
he was delirious a greater portion of the day. 7'he calomel and oil not ope- 
rating, he took occasional doses of Epsom salts as the fever advanced. As the 
evening approached the fever left him, however, and thinking it only an inter- 
mittent, to which he was subject, he took ten grains of quinine in pills during 
the evening, and, as before mentioned, slept well until awoke by the sick- 
ness and pain. The medicines he had taken had produced but two slight 

1843.] Peebles' case pf Calculus in Appendix Vermiformis. 123 

evacuations; his urine was scant and very high coloured, and whilst there 
was a frequent desire for its discharge, it was voided with some difficulty. 
My first impression was that nothing else could produce symptoms so sud- 
denly urgent and distressing, and at once I instituted inquiry as to the exist- 
ence of stricture in some portion of the intestinal tube. The patient had 
inguinal hernia, an unusually large protrusion, but it was reducible, and when 
reduced, the ring could plainly be felt throughout by the finger. There could 
then be no strangulation of the intestine, and to fulfil the indications, to- 
gether with the warm bath, and fomentations applied to the seat of pain from 
time to time, three pills, made according to the following formula, were or- 
dered to be taken immediately, to be followed by the remainder in two hours, 
should not the first produce relief:— Hydrarg. submur. 9i., pulv. g. camph. 
gr. viii., pulv. g. opii, gr. ii.; m. fiant pilidee vi. aequal. I saw him again in 
six hours. There was now reaction, and his skin was hot and dry. The 
first dose of pills had produced relief, with great drowsiness, from which the 
slightest touch would awake him with a start, and during which there was 
continued twitching of the tendons. There was no pain in the right groin, 
but the soreness was so great that he could not bear the slightest touch or 
the least motion. The thirst had not abated, and the irritability of the sto- 
mach had increased. The tenderness was now extended over towards the 
right groin. His bowels had not been opened, the injections which had been 
administered being still retained. Although reaction seemed completely 
established, his pulse was thready and compressible. Venesection being im- 
practicable, thirty leeches were ordered to be immediately applied over the 
tender region. The application of a sinapism composed his stomach, and 
he was enabled to retain a dose of castor oil. 

"When seen again in the evening, he had had several dark and highly foetid 
evacuations, and there was evident relief. The tension of the bowels had 
diminished, and there was not so much tenderness on pressure. His fever 
had subsided, and with it the subsultus and drowsiness, whilst his skin gave 
out a warm perspiration. His thirst had left him, and with it much of the 
irritability of his stomach. In short, the patient seemed amended in every 
way, and was comparatively quite comfortable. Fearing a return of the chill 
in the morning, corresponding to the one which had seized him on the morn- 
ing previous, he was ordered to take twelve grains of quinine at bedtime. 

AJonday. Summoned again at 4 o'clock. I found the patient labouring 
under symptoms precisely similar to those of the previous morning-; if pos- 
sible, his agony was greater; as then, he had slept well until awoke at that 
hour by his suffering. The pain had extended, and now occupied both the 
right and left iliac regions, over which space the abdomen, without being much 
distended, was tense and firm, and so extremely sensitive, as not to endure 
the slightest touch. It darted down most excruciatingly to the anus and orifice 
of the urethra, and the penis was contracted marvellously, and firm and rigid 
to the touch. His desire for cold drinks was extremely urgent, and, such was 
the irritability of his stomach, they were ejected almost the instant they were 
swallowed. The warm bath relieved the intensity of his sufferings for an 
instant, and he retained three pills similar to those prescribed on the previous 
morning. Ordered thirty leeches to be immediately applied, extending over 
the right and left iliac regions. 10, A.M. The leeches had just been re- 
moved when I called. Perspiration had just broken out, and the patient had 
fallen into a slumber. His pulse continued sharp, but extremely compressi- 
ble. His repose was only momentary, and when he awoke, I found the 
symptoms wholly unabated. Several injections had been given without open- 

124 Ve.ehXes'' case of Calculus in Appendix Vermiformis, [Jan. 

ing his bowels, and the abdominal tension had gready increased, as had also 
the tenderness and pain. His thirst had continued, and the vomiting was in- 
cessant, and for the first time there was now some slight indications of ster- 
coraceous matter sinking in the bottom of the vessel. The condition of the 
niian was in the highest degree alarming, and the treatment having fallen so 
far short of relief, a consultation was requested. Whilst a note was being 
written for aid, the patient, getting up to stool, voided a copious and extremely 
offensive slate-coloured evacuation. The most urgent symptoms at once sub- 
sided, and he expressed himself so much relieved, that the order for consul- 
tation was countermanded. He was enabled to retain an oleaginous emul- 
sion, which by the evening produced five copious discharges, similar in cha- 
racter to die previous one. The pain had then subsided, and the tension of 
the bowels was diminished, although not so much as miglit have been looked 
for after such free catharsis; the seat of the pain still remained firm to the 
touch, and presented the peculiarity, that whilst he could not endure over 
it the slightest percussion, pressure gradually increased could be borne to an 
almost unlimited extent. His thirst was not troublesome, and the vomiting 
had almost entirely ceased. A full anodyne was ordered to be given at 3 
A. M., so as to break the apparent intermittent recurrence of the attack at 4 
every morning, and he was left for the night. 

Tuesday^ Ih A. M. Although he had not slept much, he had had a more 
comfortable night than he had enjoyed since his illness. He was engaged in 
cheerful conversation, and expressed himself much better. The tension, 
pain, and soreness of the bowels were still relieved in a great degree, yet my 
hopes for his safety were much shaken by learning that he had occasionally 
been troubled with hiccough during the night, and moreover, by the continu- 
ance of the thirst and vomiting, which had rather increased since the previ- 
ous evening. To relieve these, a large blister was ordered to the epigastrium. 
His pulse being still sliarp, and more tense than it had been, leeches were 
again ordered to the right iliac region. 1^, P. M. The symptoms had be- 
come gready aggravated in every respect, and the condition of the man, so 
long doubtful, had now become unequivocally hopeless. The pain, soreness, 
and tension, was extended over the entire abdomen (the greatest suffering 
being now in the hypogastric regions), and the torture of the man was be- 
yond description. With a constant desire for cold drinks, there was inces- 
sant vomiting of the fluid, mixed with stercoraceous matter; and superadded 
to this, hiccough had returned, at shorter intervals, to the inexpressible tor- 
ment of the poor man. His skin was bathed in warm perspiration, the pulse 
had lost some of its sharpness, whUst its beat was quicker, and the artery, 
during its inacUvity, seemed more filled than it had previously been. The 
patient, in entreating to be bled, informed me that he had, twelve years pre- 
vious, been relieved of a similar attack which had seized him in the city of 
Troy, N.Y., by his physician's bleeding him to fainting. It was totally 
impracticable, and morphine was administered, and the blister extended over 
the abdomen. 7, P. M. Visited Mr. C r in consultation with Dr. Rob- 
inson. It was the latter's opinion that the treatment would have relieved 
the man, had not there been some local cause to produce the inflammation, 
and since it had not, it, in his opinion, strengthened my first impression, tliat 
there was stricture in the hernial ring. After another minute examination, 
this could not be found to exist, and nothing was left us but to relieve the 
tension by speedily opening the bowels. Croton oil was ordered, but the pa- 
tient could not retain the dose, and after a night of exquisite torture, he sank 
and expired, at a few minutes past four on Wednesday morning. 

1843.] Peebles' case of Calculus in Appendix Vermiformis. 125 

Autopsy. — A hasty examination was permitted ns, and seven hours after 
death, kindly assisted by Dr. Spencer, it was made in the presence of Dr. 
Robinson. The external appearance of the abdomen was not unnsual. The 
distension was scarcely perceptible, yet its walls were uncommonly firm and 
unyielding to pressure. On exposing its cavity, the viscera, as well as their 
peritoneal covering, were found so highly injected, as to be of a dark purple 
hue, and throughout covered with coagulable lymph. The omentum was 
most unnaturally thickened, and on its surface were several sphacelated spots 
of considerable extent, having around them a more greenish appearance. 
There was an unusual absence of serous fluid, but when the omentum was 
raised, floating amid the intestinal convolutions, several ounces of pure pus 
were discovered. Although the bowels were nearly entirely void of contents, 
yet so highly were their coats injected, that they communicated a feeling of 
great firmness to the touch, and this, together with the unnatural thickness of 
the omentum, at once accounted for the firmness on pressure over the abdo- 
men, which existed the last twenty-four hours of the man's illness. The 
intestine was traced carefully down; no stricture was found to exist, and the 
hernial ring was perfectly free from any appearance of inflammation. Pass- 
ing the finger below this, in the iliac fossa, it came, near the rim of the pel- 
vis, in contact with a solid body. It was ascertained to be in the appendix 
vermiformis, fully three inches from its junction with the csecum, and which, 
without being unnaturally prolonged, was very much enlarged, at the point, 
to more than an inch in diameter. A perforation the size of a crow quill was 
discovered at the side of this enlargement, from which, as it was raised, seve- 
ral drops of pure pus dripped away. The large hernial protrusion, together 
with the weight of the calculus, (for such it was ascertained to be by an ex- 
amination through the perforation,) had displaced the appendix from its usual 
position in the body, by drawing it down to the rim of the pelvis, and when 
discovered, the calculus rested against the lower and left side of the fundus 
of the bladder inferiorly, superiorly it lay against a fold of the small intes- 
tine. It was on this side that the perforation existed; it opened against the 
small intestine, which for more than an inch above and below, was in a state 
of sphacelation. Here was evidently the point from which the inflammation 
diverged, and the surrounding organs, involving the ileum, the ileo-colic 
valve, the caecum, the descending and transverse colon, the rectum, from its 
sigmoid flexure to the verge of the anus, and the fundus of the bladder, were 
all deeply injected, covered with gangrenous spots, and loaded with coagu- 
lable lymph. The bladder was partially distended with urine, and its coats 
unnaturally thickened. Tracing the ileum from its junction with the caecum 
upwards, the degree of inflammation gradually lessened, although the duo- 
denum and the peritoneal covering of the stomach were both highly inflamed. 
The mucous membrane of the stomacli was but slightly injected; the organ 
was distended, and it contained an injection which had been administered 
several hours before death. The spleen was enormously distended. The 
liver was also much enlarged. The gall-bladder was partially filled with ap- 
parently healthy bile. 

The calculus belonged to the mulberry class; it was nearly circular, more 
than an inch in diameter through its widest portion, with a very irregular 
surface. Surrounding it, lodged in the interstices, were a number of tomato 
seed, and several of those of the currant, some of which had evidently re- 
mained there for a length of time, since they were partially incrusted with the 
calcareous matter. On sawing into it, after passing through a thin but firm 
No. IX. — January, 1843. 9 

126 Peebles' case of Calculus in Jlppendix Vermiformis. [Jan. 

crust of stone, the saw suddenly sunk into a soft substance. On layins^ it 
entirely open, the calculus was found to be a thin incrustation, filled with a 
fawn-coloured and dried matter, light and spongy to the touch; it had evi- 
dently been some organic substance, and containing, as it did, several parti- 
cles made up of distinct fibres, which were perceptibly elastic, the inference 
is fair that it was of animal origin, perhaps a bit of beef which, defying the 
powers of mastication, had become accidentally lodged in the appendix, and 
thus, in the course of time, incrusted. This substance was easily scooped 
out, and when removed, the cavity left plainly proved that it had been the 
nucleus, for the crust of stone being of the same thickness throughout, its 
shape was found to have entirely determined the external conformation of the 

It woi-ld seem that there was some discrepancy between the appearances 
on dissection and the general course of the symptoms of the above case. It 
is evident that the work of inflammation was progressive and unceasing from 
the first moment of the attack until death supervened; the relief, therefore, 
that the patient experienced from time to time, is to be attributed to the par- 
tial subsidence of the vascular turgescence, the result of the leeching, and 
the free catharsis, which for the time suspended the tension and pain. The 
apparent intermittent recurrence of the attack for two successive mornings, 
preceded, also, by a marked rigor and reaction on the forenoon of the previ- 
ous day, whilst at the time it had some weight in determining the diagnosis 
of the case, (since, by the subsidence of the symptoms towards the close of 
both days, in a great degree, it had some of the characters of inlermittent 
fever in a masked form, a disease which was extensively prevailing in the 
neighbourhood,) it was to be rather attributed to accident'^l coincidence, 
arising from the fact, that the impression produced by the remedies employed 
so happened to subside at that hour, to leave the disease to its natural course. 

There are many interesting cases of calculi in the intestinal canal recorded 
in the books and journals, some of them, indeed, so remarkable, as to be 
perpetuated in every treatise that has yet appeared on this subject; but we 
have not met with an account of a calculus such as above described being 
found in the appendicula vermiformis, and the case is therefore unique and 

Cases are not wanting, however, of disease resulting from the lodgment of 
foreign bodies in the appendix vermiformis. Acute inflammation of the cae- 
cum, terminating, if not relieved, in perforation of the intestine, or the for- 
mation of an abscess in the iliac fossa, it has been shown repeatedly, may 
result from the presence of foreign bodies, such as fruit stones, undigested 
food, or other concretions, lodged in the folds of that intestine or its appendix. 
An interesting case of a pin passing from the appendix to the bladder, has 
been recendy reported by an English physician. It cannot be uninteresting, 
whilst upon this subject, to mention a case of this nature, related to me 
by the sufl*erer, himself a distinguished physician. He had been for years 
subject to violent attacks of pain in the right groin, which subjected him to 
great annoyance. On one occasion the pain, which was confined to a spot 
over the ileo-colic valve, which could have been covered by a dollar, con- 
tinued without the slightest intermission for several weeks. After taking 
many active purgatives without a moment's relief from their operations, he 
found the pain suddenly and permanently suspended by a free evacuation, 
the result of an oleaginous emulsion with turpentine. The relief was so 
sudden and so marked, as to fix the impression on his mind that the discharge 

1843.] Peebles' case of Calculus in Appendix Vermiformis. 127 

had brought away the offending cause. An examination was made, and the 
seed of several small fruit and a number of those of the tomato, were disco- 
vered in the vessel. Some time after this, and subsequent to another attack, 
an abscess, which had been slowly but steadily forming for several weeks, 
burst outwards over the left groin, and in its discharge there again appeared 
traces of tomato seed. It healed kindly, and from that time, although seve- 
ral years have elapsed, there has been no return of his disease, and the pro- 
bability is, that adhesions have formed in the intestine, in such a manner as 
to exclude the entrance of foreign bodies from the appendix. 

The origin of the calculus in the present case was undoubtedly a frag- 
ment of undigested food, lodged by accident in the appendix; and since the 
patient had been subject to pain in that region from time to time, ever since 
his first attack, occurring twelve years previous to his death, which was so 
violent as to require the most energetic treatment to subdue it, it is not unrea- 
sonable to infer that this lodgment occurred at that time. That it should 
have become coated with calcareous matter, instead of at once, as in other 
cases, creating irritation and steadily progressing to a serious issue, is an 
interesting question. Without attempting to account for this fact, it may 
not be uninteresting to notice, that the presence of stones in the alimentary 
canals of the inferior animals, whilst it is more common than in the hu- 
man subject, is more frequent in those of a particular class. And they 
are peculiar in this respect, from their habits, the complexity of their organs, 
the length of the intestines in proportion to their bodies, and the nature 
of their food, it remains for a length of time in their intestines, in a state 
of partial inaction, thus giving ample time for the agglutination of its more 
solid portions, and the ultimate formation of calculus on these concretions. 
These stones, whatever may be their external nature, have invariably for a 
nucleus some solid substance which had been taken into the stomach as food. 
These facts furnish a striking analogy with the case before us, where the 
foreign substance, from its position, was immovable. 

Whatever may have been the history of the calculary formation, the per- 
foration, the immediate cause of death, so far from being the immediate re- 
sult of either its irritation, or the distension of the intestinal coats, (for they 
were sound except around the opening — the coats of the appendix had evi- 
dently distended to accommodats the body, and were in a natural state,) was, 
it is probable, the result of an effort of nature to free the system from the 
foreign body by throwing it into the ileum, against which, we have before 
shown, it lay. The fold of this intestine, against which it was lying, although 
sphacelated, was much thickened, and densely covered with coagulable lymph, 
proving that there had been an attempt towards adhesion, which had been 
interrupted. This fold of the ileum belonged to that portion of tlie intestine 
which formed the hernial protrusion; this protrusion invariably occurred when 
the patient was without ihis truss, at the slightest exertion; he did not wear 
the instrument at night, hence it was liable to occnr frequently during that pe- 
riod, and in its probable motion during protrusion, we think may be explained 
this fatal interruption to the adhesive process. 

The case, therefore, we think, was unfavorably complicated by the exist- 
ence of hernia, for had there not been such displacement of the organ, its 
contiguity would have led to the formation of adhesions, and the calculus 
would doubtlessly have been thrown into the caecum, from whence it would 
have found an easy exit from the body; as it was, had it found its way into 
the ileum, from its size, it is highly probable it would have found such diffi- 
cult passage as to occasion equally severe, if not fatal effects. 

128 [Jan. 


Art. W.— Memoirs of the Life and Writings of William P. Deicees^ 
M. D. By Hugh L. Hodge, M. D., Professor of Obstetrics in the 
University of Pennsylvania.* 

Dr. William Potts Dewees, the late Professor of Midwifery in the 
University of Pennsylvania, was one of the most distinguished individuals 
that has ever graced the annals of our profession in this country; his name 
is indissolubly associated with the history of our science; he found it strug- 
gling in the weakness of infancy, and left it fully established in the strength 
and privileges of manhood. 

Of the parentage and early life of our departed professor, little is known. 
His great-grandfather, and probably his grandfather, were among the immi- 
grants from Sweden, the original settlers of Delaware bay and river, and 
maintained, for a series of years, a respectable and influential character. 
His grandmother belonged to the family of Farmer, which appears to have 
been of Irish descent, their ancestors enjoying much wealth, part of which 
was invested in the purchase of immense tracts of land in this country. 
His mother was the daughter of Thomas Potts, a highly respectable Eng- 
lish gentleman, whose family first settled and gave name to Pottsgrove 
(or Pottstown) on the river Schuylkill. 

Dr. Dewees was born on the 5th of May, 1768, at Pottsgrove, and 
being early left fatherless, and with very little property, he had not the 
advantage of a collegiate education. It is difficult, however — not to 
say impossible — to restrain genius, even by the chains of poverty and 
neglect. Young Dewees improved all the means at his command, and 
must have made some proficiency in the languages, as his knowledge of 
Latin and French in after life was sufficient for all necessary purposes. He 
is represented by those best calculated to judge, as docile, industrious, very 
affectionate, and amiable. 

He early determined to study medicine, and was, for this purpose, placed 
by his father in the establishment of a Dr. Phyle, a practising apothecary, 
as was very customary at that period, when the proper distinction between 
the business of the apothecary and of the physician had not been gene- 
rally made. 

Under the superintendence, for two or three years, of Dr. Phyle, he 
appears to have acquired his knowledge of pharmacy, and its collateral 
sciences — afterwards he placed himself in the office of Dr. William Smith, 
to prosecute more especially his professional studies. During his connec- 
tion with Dr. Smith, and his residence in Philadelphia, in the years 17S7, 
'8, and '9, he attended lectures in the University of Pennsylvania. 

* This Memoir was read before the Medical Class of the University of Pennsylvania, 
November 5th, 1842. Being anxious to lay it before our readers without delay, and 
having but little space for the purpose, we have been compelled to slightly abridge it. 

1843.] Biography of Dr, Dewees, 129 

During the infancy of medical instruction in this country, the degree of 
Doctor in Medicine was seldom sought after, and in accordance, therefore, 
with the almost universal custom of the day, Dr. Dewees commenced the 
practice of his profession without receiving a regular diploma from his 
preceptors, in the summer of 1789. He was then twenty-one years of 
age, about the medium height, well proportioned, of a florid complexion, 
brown hair, rather slender make, and remarkably youthful in his appearance, 
so that great objections were frequently made to employing a physician 
apparently so very young. 

He commenced the arduous duties of our profession about fourteen miles 
north of Philadelphia, at the village of Abington, where he soon engrossed 
all the valuable practice, notwithstanding the objections made to his youth 
and inexperience, and to the deficiencies of his education. His talents, 
united with great industry and perseverance, his affectionate and amiable 
disposition, secured the attachment, and very soon the confidence, of his 
patients. In this comparatively retired spot, thrown at an early age upon 
his own resources, with no patronage but his own character and attainments, 
with no pecuniary assistance, Dr. Dewees, by sedulous attention to busi- 
ness, by careful observation of physiological and pathological phenomena, 
laid the foundation of his future usefulness and celebrity. He would often, 
in after life, allude to observations made, or to treatment pursued by him 
while a youth at Abington, confirmatory of his future theoretical and prac- 
tical views. He was soon called to a more extensive field of usefulness. 

The desolations of a terrible epidemic (the yellow fever), during the 
summer and autumn of the memorable year 1793, had extended to the prac- 
titioners of medicine in this city, as well as to the public generally. Almost 
universally they remained at the post of danger; and many fell victims to 
their humane, self-denying, and disinterested devotion to the suffering com- 
munity. The ranks of the profession in our city being thus diminished, and 
there being few instructed physicians in the country, a fine opening occurred 
for those whose education and experience gave promise that their services 
would be useful. On this occasion a Physick and a James appeared on the 
scene of action, candidates for a practice and a reputation which were sub- 
sequently enjoyed in rich abundance. The opportunity was too promising 
to be neglected by Dr. Dewees. It immediately drew him from his com- 
parative retirement among the healthy regions and the delightful scenery 
of Abington. He felt the internal promptings of a spirit that burned for dis- 
tinction—the stimulus which a consciousness of power excites in the bosom 
— and without hesitation he forsook his present prosperous career, to embark 
on a more troubled sea, whose waves had been deeply agitated by the phy- 
sical causes to which we have alluded, and also by the perhaps still more 
distressing contentions which existed among the surviving members of the 
profession, and arose from contrariety of opinions and practice during the 
recent epidemic. Under these circumstances. Dr. Dewees took up his resi- 
dence in Philadelphia, in December, 1793, as a candidate, with others, for 
professional business and reputation. 

At this important epoch in the medical history of our city, and of the 
country, he found the confidence of the public was resting upon a Kuhn, a 
Shippen, a Rush, a Wistar, and a Grifl^tts. Dr. Rush soon ascertained the 
talents and abilities of Dewees, and threw his commanding influence in 
his favour. An intimacy also took place between Physick and Dewees, 
and as their course was different, the former preferring surgery and the 

130 Biography of Dr. Detvees, [Jan. 

latter obstetrics, they assisted each other in prosecuting their respective 
plans for professional advancement. 

Independently of any collateral assistance which Dr. Dewees might have 
received from the friendship of Dr. Rush, he enjoyed one of the finest op- 
portunities that could possibly be presented for a medical man to rise to 
wealth and fame. At that period the science of obstetrics was hardly known 
in America. The physicians who occasionally engaged in its practice, 
had received no instruction, with the exception of a few, who, having vis- 
ited Europe, brought home a general knowledge of the subject, but who, 
from the prejudices existing against the emp^yment of male practitioners, 
had few opportunities and fewer inducements to perfect their knowledge. 
Hence, midwifery existed almost universally as an art: the aged and imbe- 
cile nurse was almost universally preferred to the physician. Women were 
generally the practitioners of midwifery, as few imagined any particular 
instruction necessary for an attendance on labour; at least any beyond 
that derivable from prolonged experience. Our science, however, is too 
essentially connected with the lives and happiness of individuals and fami- 
lies, to remain, for a long time, in such obscurity, when knowledge and 
science on other subjects were elevating the character and developing the 
resources of the community. As the arts and luxuries of life increased, 
the dangers and difficulties of the parturient process increased also. Ex- 
perience lamentably demonstrated that the attentions of the nurse, however 
experienced, were unavailing; yea, that the officious interference of igno- 
rant practitioners in a process so wonderful and so abstruse as that of par- 
turition, was too often productive of the most fatal consequences to the 
child and its mother, thus destroying the comfort and happiness of families. 
In such extremities, all notions of false delicacy are thrown to the winds; 
the cry for help, arising from the emergencies of the case, is imperative; 
but, alas, who was prepared to respond to the cry? Who to render the ne- 
cessary assistance? The physician, who, on such emergencies was called, 
was unprepared to afford relief; his former studies had been imperfect; his 
experience in midwifery trifling; his observation of severe cases very 
limited; and you may imagine the embarrassing and horrible condition 
in which such a practitioner must be placed, when a human being, and that 
a female, in agony supplicated for relief — when to him every eye was 
turned — when on him rested every hope of a despairing husband or a bro- 
ken-hearted mother, and he felt conscious that he ought to be able, but still 
could not afford the proper assistance. Such was the condition of our 
community some fifty years ago — such, we are sorry to affirm, is the state 
of many communities, in various portions of our country, at the present 
day — where often, very often, the cry for help bursts from the agonized 
bosom, and there is no suitable response from the instructed obstetrician. 

What greater incitement could be offered to a young medical man, con- 
scious of power, but sensible of his deficiencies, than such a state of things? 
What more extensive field of usefulness could be presented to a conscien- 
tious and philanthropic youth, burning with desire to benefit his race, than 
to labour for the preservation of mothers and their children during the 
eventful and agonizing moments of parturition? 

The opportunity, thus Providentially occurring, was embraced by the sub- 
ject of our address. He felt and realized his own deficiencies, but was deter- 
mined to overcome them. To attain the victory — -to pepare himself for the 
elevated station to which he aspired — could only be effected by rendering 

1843.] Biography of Dr. Beiveesl 131 

himself equal to the emergency. He reviewed his observations, made during 
four years at Abington, at the bedside of his patients, — he compared these 
results with the experience of others: he went still further; he commenced 
again an examination of the foundations of his science, the fundamental 
principles of obstetrics; and on these he built his stable superstructure, 
which has, and will last, to his own credit, and to the reputation of our 
school, our city, and our country. He made himself familiar with the then 
modern authorities — the Osbornes and Denmans of England, the Levrets 
and Baudelocques of France; and hence derived accurate notions of the 
science and practice of midwifery. 

His investigations, when compared with the results of his own experi- 
ence, excited a partiality for French in preference to English obstetrics. 
He chose Baudelocque for his teacher; and often declared that he was 
indebted to this most distinguished French obstetrician, for all that he him- 
self knew of midwifery. The disciple was worthy of his master. 

Thus armed for the conflict, with the ignorance and prejudices of the 
community — with the irregular, the uneducated, or the imperfectly edu- 
cated practitioners of the art, he was ready for the emergencies that might 
occur. Such emergencies were not unfrequent; for, unfortunately, diffi- 
cult cases of delivery were at that period the result, not only of natural 
causes, but very frequendy of the bad and officious practice of ignorant 
pretenders to the art, who made that labour difficult or laborious, which, 
without their interference, would have been natural and comparatively 
easy. On such occasions Dewees was often consulted; and a large por- 
tion of operative midwifery fell into his hands. For him, this was in 
every way advantageous; his theoretical knowledge became practical — 
his dexterity in operating, as well as his tact in the difficult art of diagnosis, 
was perfected; his reputation was difl'used through the community, and his 
practice, of course, became more extensive and profitable. In a short 
period, therefore, after his establishment in Philadelphia, under the con- 
joint influences of the causes mentioned, but especially by his own real 
worth and decision of character, his success was complete, and he felt that 
he might safely enlarge his responsibilities and assume new duties, while 
he added to his comforts and happiness. 

About this period he married Miss Martha Rogers, daughter of Doctor 
Rogers, of New England. Not many years after, this lady, still in all the 
bloom of youth and beauty, became the sudden victim of an acute disease, 
to the destruction, for a time at least, of that domestic comfort and support 
to which her husband had aspired, and which is so needful for all, espe- 
cially for a physician, whose mind and heart are so constantly engrossed 
with the suflerings of his fellow beings, and whose periods of relaxation 
are so rare and so imperfect. 

Dr. Dewees, soon after this period, conceived the idea of rendering him- 
self useful, not only as a praclioner, but also as a teacher of midwifery; 
the science and practice of obstetrics, being little understood in our coun- 
try, for very few and imperfect attempts had been made to impart even a 
general knowledge of this most important subject. Dr. William Shippen, 
one of the founders of the University, has the enviable reputation of being 
the first teacher of anatomy, of surgery, and also of midwifery, in this 
country; his professorship embracing these various subjects. So extensive 
were the duties incumbent on this professor, so fundamentally important 
was the subject of anatomy, and so urgent were the calls for instruction 

132 Biography of Dr, Dewees. [Jan. 

in the elements of surgery, that midwifery was necessarily almost wholly 
neglected in his course of instruction. A {ew general directions for the 
guidance of the practitioner, constituted nearly all the information imparted 
to the student at the close of the professor's lectures. 

As no one could realize more fully than Dr. Dewees the want of more 
extensive and efficient instruction on the subject of practical midwifery, 
we find that he has the high honour of first attempting a full course of lec- 
tures on obstetrics, in America. In a small office, he collected a few 
pupils, and in a familiar manner, indoctrinated them with the principles of 
our science; toiling year after year in opposition to the prejudices, not 
only of the community, but even of the profession, who could not perceive 
that so much effort was necessary for the facilitating the natural process of 

Thus favourably introduced to the citizens of Philadelphia as a practi- 
tioner, and to the professional public as a teacher of the science of obste- 
trics, his practice became extensive, and his income gready enlarged. 

He again determined to seek the advantages and pleasures of domestic 
life, and in the year 1802 became united to his second wife. Miss Mary 
Lorrain, daughter of John Lorrain, a respectable merchant in Philadelphia. 
In this connection, he was greatly blessed: Mrs. Dewees was preserved in 
health and strength as the partner of his prosperity and adversity, enjoying 
with him the innumerable favours which Providence in the course of a 
long life had abundantly bestowed, and sharing with him those painful 
reverses that occurred in the latter periods of his life. By this marriage. 
Dr. Dewees became the father of eight children — three daughters and five 
sons — most of whom survive him. 

Thus successful in his public exertions, blessed in his domestic rela- 
tions, the object of attention to a large circle of friends, with whom he 
reciprocated those social attentions to which the natural warmth of his 
feelings and the sincerity of his friendships constantly inclined him, Dr. 
Dewees pursued the steady course to a still more extensive reputation and 

The practice and the science of midwifery were daily gaining import- 
ance in the judgment of an enlightened community. Their immense value 
in preserving life, in ameliorating suffering, in preventing continued and 
destructive disease, were more and more recognised. The necessity, 
positive and imperious, of employing as practitioners only those who were 
suitably indoctrinated, became acknowledged. The practice of allowing 
females to officiate was constantly diminishing; and the public attention 
became more steadily fixed on a Dewees, and a James, as the proper repre- 
sentatives of obstetric science, as those best calculated to give it practical 
efficiency. It soon become evident that midwifery would be regarded in 
a more important light by the Trustees and Professors of the University 
of Pennsylvania; that the time could not be far distant when it would be 
detached from its inefficient and subordinate connection with the anatomi- 
cal chair,* and be separately taught in this model school of American 

To be prepared for this event in every respect was now no easy task. 
Competition had already existed for years with many distinguished indi- 

* Surgery had already been severed from Anatomy during- the lifetime of Shippen; 
and was rendered a distinct and coequal Professorship under the direction of the father 
of American Surgery, Dr. Physick, June 5th, 1805. 

1843.] Biography of Br. Bewees, 133 

viduals, especially with Dr. Thos. C. James, his cotemporarj^ and who, 
in addition to the possession of fine talents, an excellent education, 
great personal attractions and influence, was also a lecturer on the science 
of obstetrics, having commenced his course of instruction with the late Dr. 
Church in 1801. New competitors were also appearing; and one, al- 
though young in the profession, a graduate of 1801, who had just returned 
from Europe, yet by the brilliancy of his talents, his popular address, and 
the influence of his former friends in Virginia, and his social connections 
in this city, obtained an influence as a practitioner, and soon as a teacher 
in obstetrics, which threatened to distance all his rivals. I allude to Dr. 
Chapman, the present distinguished Professor of the Practice of Medicine 
in this University, who, on the death of Dr. Church, became associated 
with Dr. James, in 1805, as a lecturer on obstetrics. 

Dr. Dewees immediately determined to strengthen his position in public 
estimation, by attending to the forms, as he had done to the essentials of 
the profession. He applied, in the spring of 1806, to his Alma Mater for 
a diploma, that he might be fully entided to the appellation of Doctor in Me- 
dicine, as he had for years been engrossed with the duties and responsibili- 
ties of the profession. On this occasion he wrote an elaborate Thesis, on the 
means of moderating or relieving pain during the process of parturition, in 
which he assumed the broad ground, that pain was an accidental or morbid 
symptom of labour, — the result of artificial modes of living and treatment, 
to be moderated or destroyed by medical means. Whatever opinion may 
be entertained as to this general proposition, there is litde discrepancy of 
sentiment as to the efficacy of the remedy chiefly relied upon by Dr. De- 
wees, i. e. copious blood-letting; nor as to the fact, that to him, the profes- 
sion, and through it, females universally, are under the highest obligations 
for the introduction of this measure into efficient practice. The Professor 
of Anatomy, Dr. Shippen, declared that "it marked an era in the history 
of Medicine," and exclaimed "how much misery might I have prevented 
had I known it forty years ago!" 

The anticipated crisis respecting the establishment of midwifery as a 
distinct professorship, did not occur until the year 1810; so slow is the 
progress of truth, so difficult to illuminate the minds of men as to their 
true interests. 

For this elevation of obstetrics to its legitimate station, we are much in- 
debted to the late Professor of Anatomy, Dr. Caspar Wistar, who, in 
January, 1809, soon after he succeeded Dr. Shippen as Professor of 
Anatomy and Midwifery, urged, in a written communication, the Trustees 
of the University to have obstetrics separately taught in the school. An- 
other year was suffered to elapse; and it was not until the 11th of April, 
1810, that the resolution passed the board constituting midwifery a dis- 
tinct Professorship; even then, with the miserable proviso, that an attend- 
ance on its lectures should not be essential for graduation. 

The struggle for the new chair in the University was very warm, and 
the claims of opposing candidates, and the influence of their respective 
friends, rendered the event doubtful. The strong claims of Dr Dewees, 
his talents, his industry, his attainments, his dexterity, boldness, decision 
and judgment as a practitioner, his great success in the practice of his art, 
and as a teacher of its principles, his popularity, supported by the strongest 
testimonials from many of the distinguished men in the profession, includ- 
ing Rush and Physick, were met by analogous claims of opposing candi- 
dates, Dr. James, and Dr. Chapman. 

134 Biography of Dr. Dew ees. - [Jan. 

On the 29th June, 1810, the decision was made by the election of Dr. 
Thomas C. James to the new Professorship, the first in this country. 
This disappointment to the long cherished hopes and expectations of Dr. 
Dewees was certainly great, but involved no loss of character, as the most 
ample testimony was borne as to his qualifications and character, and the 
public confidence in his skill was entirely unabated. It could only be said 
that his influence with the Board of Trustees proved to be weaker than 
that of his rivals. 

Dr. Dewees, turning his attention from the teaching to the practice of 
obstetrics, devoted himself, with renewed energy and success, to the active 
duties of his profession, occasionally allowing himself some relaxation in 
the pleasures arising from social intercourse, and also from indulging a 
natural taste for painting and music. For these arts he early manifested a 
decided inclination; and, although he never allowed himself time to study 
them in detail, yet for both he entertained the feelings and enthusiasm of 
an amateur, and was often refreshed by their agency amidst the anxieties 
of his self-denying and engrossing profession. 

So devoted, however, was he to business, that his health, although it 
had been generally excellent, could not withstand the baneful influences 
arising from loss of sleep, irregular hours, laborious occupation, and con- 
tinued mental and moral excitement, to which every practitioner of medi- 
cine, especially an obstetrician, is constantly exposed. His breast became 
delicate, and on several occasions he was threatened with hemorrhage 
from his lungs. 

This dangerous indication of pulmonary afl'ection, conjoined with a 
tempting pecuniary investment, induced Dr. Dewees, in the year 1812, to 
resign his profession, with all its honours and tempting prospects, and to 
remove to Phillipsburgh, where he invested the proceeds of a life of toil 
and self-denial. Disappointment followed this speculation, and a few 
years sufliced to destroy the property Dr. Dewees had been years in ac- 
cumulating. His health, however, improved, and all fears of pulmonary 
disease having vanished, he returned in the fall of the year 1817 to the 
scene of his former prosperity; again a poor man, as regarded pecuniary 
matters, with a large family dependent on him entirely for support, but 
rich, in reputation for talents, industry, and success in his profession. 

His immediate wants being supplied by the kindness of professional friends, 
he resumed his private course of instruction to medical students on mid- 
wifery, and the practice of his profession. He soon became connected 
with Drs. Chapman and Horner in the Medical Institute of Philadelphia, 
founded originally by Dr. Chapman, about the year 1817, and to its suc- 
cess Dr. Dewees greatly contributed, from the period mentioned until 
1832, when age, and other pressing circumstances, induced him to resign. 

As a practitioner his success v^'as again complete; his former patients 
welcomed his return; and his increased reputation, supported now by the 
observations and experience of a long course of active professional duty, 
soon enabled him to discharge his pecuniary obligations, and to furnish 
him with the comforts and luxuries of life. 

He now resolved to record, for his own reputation, and for the great 
benefit of the public, the results of his experience and observations on the 
nature and treatment of diseases, and especially, as regarded his favourite 
science of obstetrics. Thus obeying the good old-fiishioned and common 
sense rule, first to study; then to practise; and finally, to teach and write; 


1843.] Biography of Dr» Dew ees, 135 

in opposition to the practice of very many who undertake to publish books 
long before they have an opportunity of verifying their opinions by their 

The first pubhcation was a second edition of his inaugural essay. The 
subsequent experience of practitioners has abundantly corroborated the 
advice of Dr. Dewees urged in this essay, as to the advantages of free 
bleedings in cases of rigidity — advantages not only of a positive character, 
in favouring relaxation, lessening pain, and hastening the process of partu- 
rition, but, also of a negative character, perhaps still more valuable, in pre- 
venting a vast amount of suffering, mental agitation, disease, and also of 
death. Would that his precepts were still more extensively studied, and 
more frequently acted on. Would that many, eminent in the profession, 
would sit at the feet of this Gamaliel, this teacher in medicine, and imbibe 
some fundamental notions of the importance of medical, and the dangers 
of surgical measures in cases of tension and rigidity of the soft parts dur- 
ing the process of labour. We should then, no doubt, hear less of some 
of the terrible cases in midwifery than at present. 

After this Dr. Dewees collected his scattered essays, which, for a series 
of years, had been occasionally presented in the medical periodicals, and 
republished them in a distinct volume. This was in 1823. The charac- 
ter of these essays is generally practical; indeed, all have a bearing on the 
opinions and duties of a practitioner, although some are of a theoretical 
and controversial character. In all of them, we find displayed the great 
good sense, clearness and precision of their author, who seems to improve 
every subject he touches, and to carry forward the principles and practice 
of his predecessors to a still greater degree of perfection. These obser- 
vations are made, not with any design of endorsing all the opinions of Dr. 
Dewees — for this cannot be done, as no doubt many of them are untenable, 
especially those which are merely speculative, and those which are connected 
with the very imperfect physiology of the day — but, with the important 
object of characterizing the writings of an individual who has accomplished 
more for obstetrics than any man of our country, and who has elevated him- 
self, by the character of his publications, to a station of high authority in 
the profession. He is our representative to other nations on the science 
of obstetrics, and as such is continually quoted by European authorities, 
as if he constituted one of their own number.* This is high distinction, 
and the more worthy of admiration as attained by mere force of character 
— by talent, industry, and sedulous attention to business, without any 
assistance from education, wealth, and other accidental influences. 

* Dr. John Ratnsbotham, of London, dedicated the second part of his "Practical 
Observations on Midwifery," to Dr. Dewees, in connection with Sir C. Mansfield 

Dr. Edward Rigby, of London, an author of a most excellent work on Obstetrics, 
which has lately been republished in this country, writes to Dr. Dewees in August, 
1834, in the following: manner: — " I trust you will pardon the liberty I have taken in 
writing to you, as well as the motives which have induced me to do so. I have been 
accustomed, for some years, to hold such frequent intercourse with you in reading- 
your admirable system of Midwifery, and work on children, that I cannot refrain from 
requesting a more direct intercourse between us," &c. &c. 

The .Tilly number of the British and Foreign Medical Review, for 1839, contains the 
following handsome compliment: — "The Philadelphia school of Midwifery has for 
many years been looked upon with great respect by the obstetricians on this side of the 
Atlantic. The high name and professional standing of Dr. Dewees, his great expe- 
rience, and, above all, his inestimable, compendious system of Midwifery and other 
valuable publications, have mainly contributed to this result." 

136 Biography of Dr. Dewees. [Jan. 

By his essays, Dr. Dewees has done much in ameliorating suffering 
and prolonging life, by inculcating good principles, and insisting on a bet- 
ter practice. For example, in one paper he ably sustains the important 
idea that labour, in the human species, and especially in the upper walks 
of life, ought not to be so exceedingly painful as it is usually observed; 
and that, by proper attentions, even under all the disadvantageous influ- 
ences of civilized life, suffering may be materially lessened. 

He also ably and successfully notices Dr. Den man's celebrated aphor- 
isms for the use of the forceps, demonstrating their inconsistency and their 
dangerous tendencies, especially by restricting too much the use of these 
invaluable instruments. 

He has introduced advantageously into practice, the more extensive 
and precise use of the ammoniated tincture of guaiacum, in the treatment 
of some of the varieties of dysmenorrhcea and amenorrhcea. His observa- 
tions on puerperal convulsions, and particularly, on the essential impor- 
tance, in these horrible cases, of the free use of the lancet, are invaluable. 
To him we are indebted for the full establishment of a decided practice in 
such cases — a practice so efficient, that puerperal convulsions are no longer 
one of the opprobria medicorum; a death now being almost as rare an 
event as a recovery was formerly. 

The views taken of uterine hemorrhage, of retroversion and inversion of 
the uterus, and the criticisms upon the directions given by some high au- 
thorities in obstetrics, are almost equally important, and would alone con- 
stitute a most powerful claim to the gratitude of all those interested in the 
health and lives of females. 

After the publication of these essays, Dr. Dewees commenced the pre- 
paration of a series of systematic works, upon which after all, his reputa- 
tion must eventually depend. The reputation acquired by any one as a 
practitioner of medicine, as a successful teacher or lecturer, is after all 
ephemeral. It lives at the utmost, only during the lives of the recipients 
of favours thus conferred. The wave of another generation carries the 
name thus acquired, to a silent oblivion. He who would live in the me- 
mories and hearts of men, — or rather, — he who would be useful after his 
body has been decomposed in the grave, must record the results of a life 
of observation and labour. 

The first systematic work of Dr. Dewees, is probably his best — upon 
which he bestowed most thought and labour, — viz: His " System of Mid- 
wifery for the use of students and practitioners.''^ We have already alluded 
to the state of ignorance which universally existed throughout our country, 
on the science of obstetrics, towards the close of the last century, and of 
the light which beamed forth when a James, and a Dewees, became practi- 
tioners, and afterwards teachers of midwifery. Few or no publications 
had been made on this subject in America, and few of the foreign works 
circulated to any extent. Dr. Dewees was among the first to diminish 
this evil, by republishing in 1807, Heath's translation of Baudelocque; Dr. 
Chapman, in 1810, published an edition of Mr. Burns' (of Glasgow) prin- 
ciples of Midwifery; and Dr. Bard, of New York, the President of the 
College of Physicians and Surgeons, about the same time issued a com- 
pendium of the theory and practice of Midwifery, — designed rather to 
difl'use among ignorant midwives and practitioners, a knowledge of the 
rules for practice, as laid down by the best European authorities — rather 
than to make any attempt to enlarge the boundaries of the science. At 

1843.] Biography of Dr. Dewees, 137 

this juncture, Dr. Dewees's book opportunely appeared — the first regular 
systematic work of which our country could boast — although to Dr. Bard 
the credit belongs, of being the first one to instruct upon a large scale the 
physicians of our country in the art of midwifery. 

To an American, therefore, the appearance of Dewees's work on Mid- 
wifery, is an important epoch in the history of our science, as being the 
first regular attempt to think for ourselves on tokology, and to contribute 
to the onward progress of this important division of medical science. It is 
the more important from the intrinsic value of the book, which, with all 
its deficiencies, probably constitutes now, at the expiration of twenty 
years from its original publication, the best practical book in our profes- 
sion, — a book, gentlemen, which every one of you, as obst&tricians, and 
especially as American obstetricians, should undoubtedly obtain and care- 
fully study. It is founded on the French system of obstetrics, especially 
on that of Baudelocque. It takes a stand decidedly in advance of Den- 
man, Osborne, Burns, and other English awthorities in general use in our 
conntry at that period, and even of Baudelocque himself, in throwing aside 
from his excellent system much that was useless, and, it may be said, 
imaginative. On the mechanism of labour, on the details of natural and 
preternatural deliveries, and on the scientific rules for the safe conduct of 
labour, founded on a knowledge of the process of delivery, the system of 
midwifery by Dr. Dewees is exceedingly valuable as far as it goes: and 
it advances farther than any work of the day. That it should, on these 
points, be in the rear of the present state of the science, is the necessary 
result of the onward march of the human intellect. In what may be 
termed the medical portion of his system, Dr. Dewees may still be con- 
sidered as one of the first authorities of the day. He is, on all occasions, 
eminently practical. His directions are clear and decided — his practice, 
founded on scientific research, and directed by great prudence and judg- 
ment, is always efficient — yet never rash. He affords to the suff'ering 
female all the relief which science and experience can impart, yet never 
endangers her life or her welfare, or that of her unborn offspring, by inter- 
fering improperly in the complicated and wonderful process of delivery. 
He studied nature: at the bedside, he became conversant with the details 
of natural delivery; he discovered what could be accomplished by the 
efforts of nature, and what could not: he learnt when the instructed prac- 
titioner should quietly wait for the development of the physiological actions 
of the female system, in silent admiration at the wonderful arrangements 
of a merciful Creator, and where, also, the resources of science were 
demanded in facilitating these actions, or in actually interfering for the 
safety of the mother or her infant. He was not to be numbered among 
those, on the one hand, who are the advocates of a "meddlesome mid- 
wifery," continually doing mischief through their ignorance and rashness; 
nor, on the other hand, will you ever find Dr. Dewees among those ineffi- 
cient practitioners, who will never do good through fear of doing evil; who 
are so afraid of the abuse of artificial resources, they will never use them; 
who will allow, with the utmost indifference, the agonies of parturition to 
continue hour after hour, day after day, endangering the safety of the tis- 
sues, functions, and life of a delicate female, involving the welfare of her 
infant also, for fear of assuming responsibility; for fear he should be re- 
garded by the timid or jealous ones as fond of interfering with nature's 
processes, as anxious to employ medical or surgical measures upon all 
occasions. Read his system of midwifery, and you will discover how 

138 Biography of Dr. Deicees. [Jan. 

prudence aiul judgment are united with boldness and decision; how the 
practitioner is represented as the servant of nature, ready, at the instant, to 
facilitate all her efforts for a safe and rapid termination of inexpressible 
sufferings; always on the alert to detect any deviation from the proper 
course of delivery — on the alert to afford the required assistance, whether 
by medical or surgical measures. You will find him estimating rightly 
the value of human life, whether infantile or maternal, sympathising with 
human suffering, and anxious, on all occasions, to alleviate, shorten, or 
destroy the pains and anxieties, mental as well as corporeal, of the process 
of parturition. 

That the work is not perfect, is to say that it is a human production; 
that it is not embellished by fine writing, and that occasionally it is diffuse, 
indefinite, and illogical, is the misfortune not the fault of the author. On 
the contrary, these very defects show the obstacles he had to overcome, 
and contribute to indicate more fully the native talent, the good sense, the 
great industry, and the practical efficiency of our Americayi Baudelocque, 
whose name is inscribed upon the roll of fame, as one of the first of ob- 
stetric authorities — our representative in the general republic of science, on 
the subject of obstetrics. Nine editions of the system of midwifery have 
appeared, and no doubt a long period will elapse before subsequent autho- 
rities will be preferred to one, now so eminent at home and abroad. 

Having contributed so much for the welfare of mothers, by his work on 
midwifery, he has contributed greatly to the suitable management of 
infants by his next systematic work, "^ Treatise on the Physical and 
Medical Treatment of Children,'''' published in 1825, and which has now 
passed through seven editions. 

As its predecessor, this work is in advance of the doctrines and practice 
of the day; and for all practical purposes, irrespective of certain patholo- 
gical views and scientific details, may still be regarded as unrivalled, not- 
withstanding the numerous publications on the management of infants and 
children with which the press has been loaded. 

Dr. Dewees investigates the influence of the mother on her child, espe- 
cially during pregnancy and lactation; he displays the importance of the 
physical management of infants, during the first weeks and months of life, 
as well as subsequently, and enters his decided protest against the prejudices 
and malpractices of ignorant and unskilful attendants, and points out, with his 
usual minuteness and discrimination, the modes of preserving health and 
life, of preventing and of curing the diseases of this helpless, but suffering 
portion of the community. To him we are greatly indebted, simply for 
fixing attention on the physical management of children, independently of 
the high value of his directions; for, prior to this period, the profession in 
this country left the details almost exclusively in the hands of nurses and 
midwives, with all their tormenting ignorance and oificiousness. 

In 1826, only one year after the publication of the work on children, 
appeared an elaborate volume, ".^ Treatise on the Diseases of Females,''^ 
another standard work in our medical literature. Such a publication was 
much wanted, and was readily received by the community, as well as by 
the profession, as high authority. It circulated, as well as its predecessor, 
very rapidly in every part of our land; and it became, what it still is, the 
book for reference in all questions of practice, on the important, delicate, 
and difficult subjects which it embraces. 

We cannot particularise, but would remark, in passing, that it bears the 
general character of the works of the author, as being dictated by great 

1843.] Biography of Dr. Deivees. 139 

decision and judgment, the result of much reading, but especially of care- 
ful and minute clinical observation. Hence, as a necessary consequence, 
from such an observer and practitioner, it adds materially to our knowledge 
of complaints exceedingly difficult to investigate, gives a precision and an 
efficiency to practical rules which were every how desirable, and has thus 
greatly ameliorated the sufferings of females, and procured much health 
and happiness to this afflicted, but too much neglected portion of the com- 
munity. On the subject of prolapsus and retroversion of the uterus, it 
may, in addition, be remarked, that to no one individual are females so much 
indebted, in our country, as to Dr. Dewees, for fixing professional atten- 
tion on the prevalence of these complaints, their importance, their distress- 
ing character, their proper treatment by means of pessaries, and especially 
for his improvement in the form of these instruments, and in the material 
of which they are composed; recommending the glass or metallic instru- 
ments in preference to the perishing materials previously employed, and 
which, from this cause chiefly, were the source of so much irritation, as to 
bring these invaluable assistants into great disrepute. 

The last of the systematic works issued by our professor was on the 
practice of medicine, in the year 1830. Encouraged by the success of his 
former appeals to public, as well as professional attention, and anxious 
that those individuals who were remote from medical advice on the fron- 
tiers of our country, should have some means at command to assist in the 
management of their complaints, Dr. Dewees was induced to prepare a 
digest of his experience on the various diseases of the human system, with 
a view to popular as well as professional patronage. He in part succeeded, 
as no one can deny the excellency of the practice usually inculcated by 
Dr. Dewees. Still, the book has no pretensions to a scientific arrange- 
ment or treatment of diseases; and being prepared hastily, and with re- 
ference to popular use, does not partake largely of the confidence of the 

While thus much engaged, during a period of more than seven years, in 
making large and valuable additions to our medical literature, the attention 
of Dr. Dewees was in no degree diverted from his practice. How he 
accomplished so much is wonderful; how a man, engaged night and day 
in the general practice of his profession, and especially in the'harassing 
duties of obstetrics, could so rapidly and efficiently labour with his pen, 
can only be explained by allowing him a happy combination of physical, 
as well as mental powers; as rare as it is desirable. His mind, indeed, 
never seemed to be fatigued; always on the alert, it would, even after great 
physical exertion, after the loss of rest and sleep, revert from one subject 
of thought and anxiety to another, and, at any moment, be directed from 
the anxious contemplation of a dangerous case of disease or of labour, to 
the quiet, but engrossing business of an author, with its memory, acute- 
ness, judgment, and every other faculty, ready for active exercise. 

Another explanation is, that Dr. Dewees well knew the value of mo- 
ments of time, and could well improve them. He never suffered them to 
be lost, and could, as he has often affirmed to the speaker, carry on a train 
of thought, or an argument, for a few moments, and then, after hours of 
interruption, resume the current of his thoughts, and immediately prosecute 
his writing. 

During this portion of the life of Dr. Dewees, various changes by death 
and otherwise, had occurred in the University of Pennsylvania, to which 
we need not allude at the present time, excepting to state, that the health 

140 Biography of Dr. Dewees, [Jan. 

of Dr. Thomas C. James, the Professor of Midwifery, had visibly declined, 
so that he stood in need of assistance in carrying on the course of lectures. 
This had been partially rendered, as regarded the anatomical portion of the 
lectures, for some years, by Dr. Horner; but in 1825, it was resolved by 
the trustees, at the request of Dr. James, that an adjunct should be ap- 
pointed to the chair, and on the 1 5th of November, 1825, Dr. Dewees 
was unanimously elected to this station, during the existence of the then 

Dr. Dewees, on his entrance into the University, was fifty-seven years 
of age, in full possession of his mental and corporeal faculties. His figure 
had spread considerably — so tliat he could be termed portly — while he 
maintained a comparatively youthful appearance, from his florid complexion 
and brown hair, still without the silvery gloss of age. The duties of the 
professorship gradually devolved more and more upon him as Dr. James 
declined in health, and Avere discharged in a manner very acceptable to the 
students. Of course, there was no great display of eloquence or erudition 
in his lectures, but he was always clear, decided, precise, and minute in his 
directions, speaking in rather a conversational style, with the promptitude 
and confidence of a man who had formed his own opinions by his own 
observations, and illustrating all that he taught by a rich fund of eases and 
anecdotes, drawn, in a great measure, from what he had himself witnessed. 
Such a teacher could not be otherwise than interesting, and, from the whole 
character of his mind, with its endowments, natural and acquired, you may 
readily conclude he must have been exceedingly valuable. His popularity 
was great, and his usefulness became thus greatly extended; his pupils 
distributing his fame, as well as his valuable instructions, throughi;he extent 
of our country. . 

For several successive years Dr. Dewees reaped, in every way, the har- 
vest resulting from his long and persevering eff'orts in the cause of medical 
and obstetric science. His income from his practice, his books, and his 
professorship, was ample for his present and prospective wants; he was 
admired, beloved, and trusted in the community in which he moved; he 
enjoyed an enviable reputation in America and Europe, and was continually 
receiving testimonials, in various ways, of the estimation in which his cha- 
racter and works were held. He had been, for a long series of years, a 
member of the American Philosophical Society, and was continually re- 
ceiving certificates or diplomas from medical and other scientific bodies in 
the United States, in the Canadas, and in Europe, with the gratifying intel- 
ligence, that they considered themselves honoured by adding his name to 
the list of their members; while private letters from distinguished physi- 
cians confirmed, and rendered still more gratifying, these public manifesta- 
tions of regard and confidence. In the domestic and social circles, his 
prosperity was equally great, and his warm heart was continually engaged, 
as far as more important business would permit, in reciprocating convivial 
enjoyments with his friends and fellow-labourers, within and without the 
profession; while, notwithstanding the lapse of years, his health and 
strength continued vigorous and active. 

These blessings were continued, without interruption, until February, 
1834, when a comparatively trivial accident, a sprain of his ankle, became 
the turning-point of his prosperity— the commencement of a series of trials 
which continued to the close of life. Owing, probably, to the confinement 
to the house, in consequence of his accident, his system became gradually 
plethoric, and he suffered from the want of his accustomed enjoyment of air 

1843.] Biography of Dr. Dewees. 141 

and exercise. In the month of April he suddenly became apoplectic, but 
owing to the timely assistance of his friends, Drs. Hays and Chapman, the 
dangerous symptoms were arrested, but his corporeal faculties were decidedly 
impaired. Cessation from business, travelling, and recreation, were so far 
successful, that in the fall of 1834 he was able to return to his practice, and 
received from the trustees of the university the unanimous appointment of 
Professor of Midwifery, Dr. James, from his great infirmities, having re- 
signed this office, which he had the honour to occupy for twenty-four 

With some of his former vivacity, Dr. Dewees was enabled to discharge 
the duties of his professorship during the ensuing winter. The exertion 
was, however, too great. In the spring his health was more impaired, and, 
notwithstanding every attention from his medical friends, and the influence 
of a change of air and travel, the autumn of 1835 found him weakened in 
mind and body. He made an attempt to deliver the winter's course of lec- 
tures, but it was apparent to himself, as well as to others, it was altogether 
futile, and on the 10th of November he resigned his professorship in the 
University of Pennsylvania. 

This mournful event, to his colleagues, to the students assembled to re- 
ceive the results of his long tried observations, to the university, and to the 
public, was not suffered to pass unnoticed. Flattering resolutions, ex- 
pressive at the same time of their sympathy and regrets, were passed respect- 
ively by the board of trustees, by the medical faculty, and by the assembled 
students. The latter were characterised by the warmth of feeling so inter- 
esting in young men; by the expression of their high respect and confi- 
dence in his talents and attainments, in his honour and rectitude of purpose; 
of their gratitude for the favours received at his hands, and especially for 
the invaluable services he had rendered them and the medical public by his 
lectures and his works, his oral and written instructions. Anxious to honour 
their afflicted teacher, to bear testimony to the sincerity of their declara- 
tions, and, at the same time, to evince to posterity the gratitude and affec- 
tion which his talents, industry, and virtue had excited in his pupils, they 
resolved to present to the retiring professor a magnificent silver vase, with 
the following inscription: 



Late Professor in the 


By the 


As a testimonial of their respect for bis exalted worth and talents. 


*' Sempir honos, nomenque tuum, laudesque manehunty 

Thursday, the 25th November, 1835, was the day appointed to make 
the presentation. The scene was most interesting, and could never be 
forgotten by those who were witnesses and actors on the mournful occa- 
sion. To behold this room, the arena of his former efforts to instruct and 
edify, crowded to excess by physicians and students, anxious to pay their 
No. IX. — January, 1*843. 10 

142 Biography of Dr. Beivees. [Jan. 

last respects to one so respected and beloved — to behold the venerable 
professor, famous, in both worlds, for his contributions for the alleviation 
of human misery, himself the sufferer, unable to sustain himself without 
assistance, seated in the centre of that beloved circle of students, to whom 
he was anxious to impart instruction, but to whom he was about to bid a 
long, a last farewell — to witness the great man, the bold, decided, energetic 
practitioner, bowed down under the influence of physical feeling, and the 
overpowering moral sentiments by which his bosom was agitated — to hear 
the chosen representative of affectionate pupils proclaim his talents, his 
virtues, liis attainments, and to testify, by words and actions, their grati- 
tude and affection — to discover that the deserved recipient of all these at- 
tentions was so overwhelmed by conflicting feelings, by the remembrance 
of the past, the solemnities of the present, and the prospects of the future, 
that words failed him to express his gratitude, — that another individual, his 
long tried friend and colleague. Dr. Chapman, had to pour forth the ac- 
knowledgments of his grateful heart, for such sincere and lasting testimo- 
nials from his beloved disciples, all constituted a scene so impressive, that 
the voice of eloquence alone could do it justice. It was a scene for the 
painter, or for the poet. It was one of those delightful manifestations of 
the best feelings of the human soul, rarely, it is true, to be witnessed, but 
the more impressive from its rarity in this world, where selfish feeling too 
generally predominates, and stifles the warm aspirations of a generous 
and noble nature. 

This hour may be considered the last of the professional life of Dr. 
Wm. P. Dewees. He retired from the scene of his labours to embark for 
Havana, in the Island of Cuba, in search of health and strength. The ex- 
periment was not wholly in vain. He recovered sufficiently to attend to 
some of the lighter duties of a practitioner in medicine, which he dis- 
charged chiefly at Mobile, in Alabama, where he spenf most of his time 
for more than four years, receiving marks of confidence and attention from 
his professional brethren of the south — most of them his former pupils. 

In 1840, lie left Mobile for Philadelphia, where he arrived, after spend- 
ing some months in New Orleans, on the 22d day of May, 1840, but he 
was an altered man; his physical frame had dwindled away under the in- 
fluence of disease, and, although his mind retained much of its original 
acuteness, he appeared as the representative of the past, rather than a 
member of the present generation. 

Our cold weather proved unfavourable to his strength and health, 
causing congestions of his vital organs, and producing so much distress 
and suffering, that he was anxious to be released from a world in which 
he felt that he had finished his work. Such, however, was the strength 
of his constitution, that this solemn event did not occur until the 20ih of 
May, 1841, when his anxious spirit was released from its earthly and 
suffering tabernacle. 

On the news of his death, a special meeting was called by the Philadel- 
phia Medical Society, and resolutions passed expressive of their deep re- 
gret at the decease of their fellow member and late Vice President — of 
their high sense of the beneficial influences exerted by his talents, attain- 
ments and professional character — and of their desire that I should prepare 
a memoir of their late admired professor. 

His funeral was attended on the 22d of May, exactly one year after his 
return to Philadelphia, by his former colleagues, the professors in the 

1843.] Biography of Dr. Dewees. 143 

University, by the members of the Medical Society, by the physicians 
and students then resident in the city, as well as by many of his former 
friends and patients, who were anxious to pay their respects to the memory 
of their friend and physician. 

" Sic transit gloria mundi." 

Such, gentlemen, is a cursory notice of the life and labours of our de- 
parted professor. On review, we must all be impressed with the belief, that 
nothing but a powerful intellect could have raised him from his state of igno- 
rance and poverty in the year 1786, to the station he occupied in 1834, as the 
first obstetric teacher and writer in these United States. As already remarked, 
the character of his mind was that of strength, rather than of brilliancy, or 
even originality; his judgment was unrivalled, and his memory most reten- 
tive. He laid hokl, with a giant's grasp, of the information within his reach, 
made it his own, and almost invariably, by careful experiment and obser- 
vation, rendered this information more complete, and carried the opinions 
and practice of others nearer to perfection. He was truly a man of genius; 
and thus, as we have seen, contributed gready to elevate his favourite 
science to its proper grade in public estimation. He was a man of strong 
and decided opinions on all those subjects, to which his attention was 
turned. Here he spoke positively, and acted with boldness and decision. 
He never failed in an object for want of nerve or decision of purpose. 
Fortunately, his judgment was so correct, that on practical subjects he 
was comparatively seldom mistaken; and hence his boldness and energy 
were productive of great good, rather than evil. Those who were his co- 
temporaries, and had the best opportunity of judging, universally bear 
testimony to his excellency as a practitioner, whatever may have been 
their estimate of his theoretical opinions. Indeed, it was almost impossi- 
ble, that he could have attained to great superiority in the theoretical de- 
partment of our profession, which demands, even for the purpose of mak- 
ing short progress, a fund of scientific information, and of literary and 
classical cultivation, with which few are favoured. 

In the practice of obstetrics, the boldness and decision of Dr. Dewees 
was of vast importance. There was no rashness in his efforts, because 
he took the essential precaution of studying the science of midwifery, be- 
fore he ventured on the difficult points of practice. He imbibed the best 
principles from the best teacher — Baudelocque of France, — and thus 
furnished, he had no want of confidence in himself, or his art, in any emer- 
gency. He never drew back and allowed his fellow beings to perish, 
when the means of relief were at command, for fear of danger or responsi- 
bility. All that could be done was done, and well done; and I have the 
authority of my now venerable colleague. Dr. Chapman, the fellow labourer 
of his friend. Dr. Dewees, for declaring, that no man was a better or 
more successful obstetric operator than Dr. Dewees, especially in the use 
of the forceps. The consequence has been, that not only did our prede- 
cessor accomplish a vast amount of good himself by means of operative 
midwifery, but he has, by his example and his instructions, vindicated this 
branch of the profession from the reproaches of the timid or ignorant prac- 
titioners, who were so terrified by the horrible consequences of mis- 
managed labours, as to dread the employment of artificial measures, even 
in cases of acknowledged difl[iculty. The daughters of America, in this 

144 Biography of Dr. Deivees. [Jan 

respect owe, and will always owe, an immense debt of gratitude to their 
true friend — Dr. William P. Dewees. 

But something more than mere talent and force of character is demanded 
to insure success as practitioners of medicine, particularly for those whose 
attention is devoted to the sufferings and diseases of the more delicate por- 
tion of the human family. The qualities of the heart must be superadded 
to talent and wisdom. In this respect, Dr. Dewees was not deficient; 
although not remarkable for polish of manner or refinement of character, 
he had warm affections, became deeply interested in his patients, sympa- 
thized with their suflferings, and, by the kindness of his manner and the 
earnestness of his attentions, impressed them with the belief, that all the 
energies of his character, and all the resources of his profession were de- 
voted to their relief. He was peculiarly happy in his conversation with 
his patients: having a cheerful, pleasant disposition, and an abundant sup- 
ply of pleasant information, he beguiled the hours of suffering, and ren- 
dered his presence acceptable as a consoling friend, as well as an efficient 
physician. He was, therefore, greatly beloved by those who depended 
on him for relief. Following him, as I have done, in his practice in this 
city, it has been a gratifying circumstance to listen to the praises of one 
who, while he occupied the elevated position which we have described, 
would bend to the voice of suffering humanity, and pour consolation and 
peace into the hearts of those who were looking to him for deliverance 
from corporeal sufferings. He was an amiable man, although endowed 
with strong feelings and a quick disposition, which would occasionally be 
manifested., like the lightning's flash, he never bore enmity, and soon re- 
turned to the enjoyment of the kindlier feelings of his nature. 

He was a man of taste as well as of genius. As already remarked, he 
was an amateur, but not a proficient, in music and painting. The walls 
of his house were covered by the productions of the masters of the art of 
painting, w^hich cost him large pecuniary sacrifices: while to music, he 
devoted much of his leisure, and was refreshed by its agency amid the 
severe duties of his profession. He was among the founders of the Mu- 
sical Fund Society, and its first president, which office he resigned in May, 
1838, after his removal from Philadelphia. 

As a friend and companion, he was always acceptable. Fond of the 
pleasures derived from social intercourse, he partook of them frequently, 
considering his pressing avocations, and always contributed greatly to the 
gratification of his associates by his cheerfulness, his vivacity, his fund of 
anecdote, and by the strength of his thoughts and expressions. 

In all his intercourse with society, he was candid, honourable, and high- 
minded. In all the domestic relations of life, the warm affections of his 
spirit were continually manifested; he contributed much of his substance 
to the support of helpless or unfortunate relatives; he was hospitable, and 
with an open hand ready to relieve the wants of his friends. As a hus- 
band, he was considerate, devoted, and affectionate; as a father, most indul- 
gent: as a brother and friend, kind and attentive. Amidst all the reverses 
of life, (and few individuals have passed more rapidly and more frequently 
from one extreme to another,) he always maintained the amiableness of 
his character, and his active devotion to business, and laboured, even to his 
last hours, through pain, weakness, and great infirmities, to supply the 
wants of a dependent family. 

1843.] 145 


Art. XII. — Animal Chemistry, or Organic Chemistry in its application 
to Physiology and Pathology. — By Justus Liebig, M. D., Professor 
of Chemistry in the University of Giessen, etc. etc. etc. Edited from 
the author's manuscript, by William Gregory, M. D., Professor of 
Medicine and Chemistry in the University and King's College, Aber- 
deen. With additions, notes and corrections, by Dr. Gregory, and 
others, by John W. Webster, M. D., Erving Professor of Chemistry 
in Harvard University. Cambridge: Published by John Owen, 1842 
—pp. 347. 

It must be matter of congratulation in the medical profession, that it 
has, as a fellow labourer in the investigation of the chemical phenomena 
of the animal organism, so distinguished a chemist as Dr. Liebig; one 
who has contributed so largely to the improvement of organic chemistry. 
Since this branch of chemistry has made such rapid advances, physiolo- 
gists and practitioners of medicine have desired that the changes taking 
place in the animal body, might be examined in their chemical relations. 
This examination is undertaken in Liebig's Report to the British Associa- 
tion. He does not consider the questions he has raised as definitely 
solved, but that so far as progress has been made, it has been by the only 
true method, the quantitative method. Some of the physiological views 
will, we think, require modification. It is the duty of the chemist to 
show that certain tissues are composed of certain elements, that the ele- 
ments of the blood equal those of bile and urate of ammonia, for instance. 
It remains for the physiologist to determine by experiment, whether the 
conclusions drawn by the chemist from such a fact be accurate or erro- 
neous. Any errors in these conclusions, it must be remembered, leave the 
facts unaffected, and, as facts, worthy of study. We shall endeavour to 
present as full an analysis of the work as our limits will allow, and espe- 
cially of those parts which may be more particularly interesting to the 

Our author introduces his report by remarks on the vital force, and its 
influence over all purely chemical action in the animal system. He does 
not, however, fully explain his views with regard to this agent in this part 
of the work, but leaves much \o the chapter on Motion, in which the sub- 
ject is resumed, and his deductions examined. Vitality is recognised in 
two states, that of rest and motion; in the animal ovum and seed of a plant 
in the state of rest, and in the same ovum and seed, after impregnation in 
the one, and by the influence of air and moisture on the other, in a state 
of motion. In this latter condition the vital force manifests itself as a 
cause of growth in the living animal tissue, and as a cause of resistance to 
external agencies tending to alter the form and composition of the sub- 
stance of the tissue, which, simply as a chemical compound, it did not 

146 Review. [Jan. 

possess. It destroys the force of attraction exerted between the molecules 
of food, allowing them to enter into new arrangements identical with 
those of the living tissues, or differing from them. Again, it appears as a 
force of attraction, since the compound formed by the new arrangement, 
when identical with the living tissue combines with and becomes a part of 
it. The manifestations of the vital force depend upon the form and con- 
stitution of the tissue in which it resides; they are also dependent upon 
temperature and upon a certain amount of food. 7'he manifestations of 
chemical forces depend upon a certain order in which the elementary 
particles are united. An analogy is readily perceived in this respect, with 
the phenomena of vitality; if the form of the body is destroyed, or the 
arrangement of the elementary particles altered, all vitality immediately 
ceases; it is inseparable from matter. 

There is nothing to prevent us from considering the vital force as a 
peculiar property, which is possessed by certain material bodies, and be- 
comes sensible when their elementary particles are combined in a certain 
arrangement or form. Considered in this view the changes which make up 
the totality of life may be investigated, and the laws which regulate them 
ascertained, as those which govern the chemical or physical condition of 
matter. This investigation cannot be conducted as rapidly or as satisfac- 
torily as those just mentioned, so numerous and complicated are the causes 
acting at each moment of tlie pursuit; still in some cases we arrive at a 
degree of certainty, little short of that belonging to the laws of mechanics 
or chemistry, "tinder this form the vital force unites in its manifestations 
all the peculiarity of chemical forces, and of the not less wonderful cause, 
which we regard as the ultimate origin of electrical phenomena. When, 
by the act of manifestation of the energy in a living part, the elements of 
the food are made to unite in the same form and structure as the living 
organ possesses, then these elements acquire the same powers. By this 
combination, the vital force inherent in them is enabled to manifest itself 
freely, and may be applied in the same way as that of the previously 
existing tissue." 

The manifestations of life in vegetables, are shown in increase of mass 
and development, and these, as vegetable physiologists and chemists have 
established, are accompanied by, and depend upon an elimination of 
oxygen, which is separated from the other component parts of their nour- 
ishment. On the other hand, the same phenomena in animal life are 
accompanied by an absorption of oxygen of the air, and by its combination 
with the component parts of the animal body. Vegetables appropriate no 
part of an organised being, until it has first undergone the process of putre- 
faction and decay, and assumed the form of inorganic matter. Animals 
require parts of organised beings for their support and development; they 
are also distinguished from vegetables by the faculty of locomotion, and in 
general, by the possession of senses. The existence of the faculties, and 
the use of them, depend upon certain parts never found in vegetables. 
The phenomena of motion and sensation, depend upon certain kinds of 
apparatus, which have no other relation to each other than this, that they 
meet in a common centre. Everything in the animal organism, to which 
the name of motion can be applied, proceeds from tlie nervous apparatus. 
While all the phenomena of motion in vegetables, depend upon physical 
and mechanical causes. They have no nerves. Assimilation goes on 
in the same way in animals as in vegetables; the same cause determines 

1843.] Liebig's Animal Chemistry, 147 

the increase of mass in both. This, which constitutes true vegetative life, 
manifests itself in vegetables with the aid of external influences; in ani- 
mals by means of influences which exist within the organism. Although 
we must admit that digestion, circulation, secretion, are under the influence 
of the nervous system, yet the force which gives the wonderful properties 
observed in the germ, the leaf, and the radical fibres of the vegetable, is 
the same as that enabling the most complex animal organ to perform its 
function. That increase may take place in the animal organism, contact 
with the substances to be appropriated is required; this is eflected by 
means of a peculiar circulating fluid, for some of the elements of which 
each cell and organ have an affinity. Physiology teaches that all parts of 
the body were originally contained in the blood. Every action of the body 
involves waste; Liebig even goes so far as to assert, that every mental 
affection is followed by chemical change. 

"The most ordinary experience further shows, that at each moment of life, in 
the animal organism, a continual change of matter, more or less accelerated, is 
going on; that a part of the structure is transformed into unorg-anised matter, 
loses its condition of life, and must be again renewed. Physiology has suffi- 
ciently decisive grounds for the opinion, that every motion, every manifestation 
of force, is the result of a transformation of the structure or its substance; that 
every conception, every mental affection, is followed by changes in the chemical 
nature of the secreted fluids; that every thought, every sensation, is accom- 
panied by a change in the composition of the substance of the brain." — P. 8. 

This conclusion, to which many would not at first yield assent, is stilN 
as we shall see further on, strictly in accordance with facts, connected 
with the other tissues of the body, which are indisputable. 

To keep up the integrity and functions of parts, thus continually under- 
going change, another process must exist, that of supply; the matter ap- 
propriated for this purpose, is in all cases a part of an organized being. 
The consideration of nutrition and reproduction constitutes the second sec- 
tion of Liebig's Report. 

If we consider the first condition upon which animal life depends to be 
assimilation of food, the second is the absorption of oxygen from the air; 
the phenomena of life are exhibited in the combination constantly going on 
in the animal body, under the influence of vital force, between the oxygen 
of the air and food. And it is from the mutual action that all vital activity 
arises. During the process of nutrition, matter passes from a state of 
motion to that of rest, (static equilibrium,) to be again set in motion, under 
the influence of the nervous system. The causes of these conditions of 
the vital force are chemical forces. Rest is the result of the aflinity 
between the particles of matter; motion arises from the changes taking 
place in the food, or in the different tissues of the body, the results of 
decomposition, just as in the closed galvanic circuit, changes taking place 
in a metal in contact with acid, produce phenomena which we attribute to 
electricity, so changes undergone by matter constituting the animal organ- 
ism, produce motion and activity, which we call vitality. This is the 
point, and no other, from which chemistry should contemplate the pheno- 
mena of life. The formation of a crystal is an enigma as well as the for- 
mation of an eye, alike difficult to solve. 

Taking the view of the animal economy here suorgested, we have imme- 
diately before us certain striking facts. An adult man receives into his 
system a certain quantity of food, and at the end of twenty-four hours he 


148 IMI^^Hp Review, [Jan. 

has neither increased nor diminished in weight; during the same time he 
has also taken into his system a very considerable amount of oxygen. None 
of this oxygen remains in the system, but is given out again in the form of 
a compound of carbon or of hydrogen, obtained from the tissues of the 
body, into combination with which the oxygen has entered. According to 
Lavoisier and Seguin, the amount of oxygen consumed daily is 32t oz., 
and the amount of carbon contained in the food of an adult man for the same 
time is 13.9 oz.; this amount of carbon escapes from the skin and lungs as 
carbonic acid gas, and to convert it into the state of gas, 37 oz. of oxygen 
are required. It is readily seen that, as no part of the oxygen escapes from 
the body, except as a compound of carbon or of hydrogen, and as these 
last must be replaced by the food, that the amount of nourishment must be 
in a direct ratio to the amount of oxygen consumed. Observation confirms 
what is here stated. The number of respirations is in proportion to the 
oxygen taken into the system; hence, a labouring man requires more food 
than one who takes but little exercise; the bird, whose respiration is rapid, 
requires more food than the serpent, which can fast for three months, and 
whose hourly consumption of oxygen can hardly be detected. The amount 
of oxygen contained in the expanded air of summer is less, bulk for bulk, 
than that of winter; hence the reduction of carbon noticed in the food of 
those living in warm climates. It is also worthy of notice, that the fruits 
preferred by the inhabitants of the south, contain but 12 per cent, of car- 
bon, while the blubber and train oil of the arctic regions contain from 66 
to 80 per cent, of the same element. 

Since the increase of mass in the animal body depends upon the ingre- 
dients of the blood, only those substances can be considered as nutritious 
which are capable of being converted into blood. The composition, then, 
of the food must be examined and compared with the ingredients of the 
blood. In considering this fluid we find two chief ingredients, the fibrine, 
which is identical in all its properties with muscular fibre, when the last is 
purified from all foreign matters, and the albumen, which is contained in 
the serum, and is identical with the white of eggs. "Fibrine and albumen 
contain seven chemical elements, among which are nitrogen, phosphorus, 
and sulphur; they contain, also, the earth of bones. The serum retains in 
solution sea salt, and other salts of potash and soda, in which the acids are 
carbonic, phosphoric, and sulphuric." It is not a little remarkable that 
chemistry has proved that the two chief ingredients of blood, fibrine and 
albumen, contain the same organic elements in the same proportion, but 
arranged in a different order, as the difference in their external properties 
sufficiently show. Fibrine has also been converted into albumen, or, at 
least, into a substance having the solubility and coagulability by heat which 
are the characteristic properties of that substance. These two substances 
may be converted, by the process of nutrition, into muscular fibre, and this 
last can be reconverted into blood. 

"All parts of the animal body which have a decided shape, which form parts 
of organs, contain nitrogen; they also contain carbon and the elements of water, 
although not in any case in the proportion to form water. The chief ingredients 
of blood contain about 17 per cent of nitrogen, and no part of an organ contains 
less than this. Experiments prove that the animal body cannot produce either 
of the elementary bodies above mentioned, carbon or nitrogen, from substances 
which do not contain it, neither is nitrogen absorbed from the atmosphere in the 
vital process.'* 

1843.] Liebig's Animal Chemistry, 149 

This point is strongly insisted upon by Dumas in his lectures; he does 
not admit that absorption ever takes place; on the other hand, as has been 
remarked by Despretz, the constant phenomenon is the exhalation of this 
gas. Indeed, the confusion with regard to the results formerly obtained by 
different experimenters on the subject, left us in doubt whether nitrogen is 
influenced by respiration in any way. Sir H. Davy and Cuvier both be- 
lieved that absorption took place to some extent; Dr. Edwards arrived at 
the conclusion that both exhalation and absorption occurred, although under 
different circumstances, dependent principally upon change of temperature. 
The latest experiments are those of Dulong and Despretz, and they have 
furnished us with evidence which is irresistible, in at least two hundred 
experiments made by them personally on the respiration of animals, exha- 
lation was in every instance observed. Water and fat are destitute of ni- 
trogen, and they are unorganized, and only so far take place in the vital 
process, that their presence is required for the due performance of the vital 
functions. Nutrition in the carnivora, we can readily see, is more simple 
than in the herbivora who take elementary particles from substances 
apparently dissimilar. But a discovery has been made with regard to the 
composition of vegetables, which greatly simplifies the process of nutrition 
in the class of animals last mentioned. It has been determined that fibrine, 
albumen, and caseine, in the animal kingdom, are represented by substances 
bearing the same names in the vegetable kingdom, and which are exactly 
identical with them in the proportion of their elements; they also very 
closely resemble them in many of their properties. The clarified juice of 
turnips, for instance, it is absolutely impossible to distinguish when boiled, 
and thereby coagulated, from the white of egg diluted with water, and heat- 
ed to the same point. The three compounds mentioned above, are the true 
nitrogenized constituents of the food of graminivorous animals; all other 
nitrogenized substances in plants are rejected by animals, as is the case 
with the characteristic principles of medicinal plants, whenever they exist 
in sufficient quantity to have any influence, as regards the increase of 
mass in the body. We see then that the vegetable principles, which in 
animals are used to form blood, contain its chief constituents, fibrine and 
albumen, ready formed, as far as regards their composition. The iron, 
which is found in the blood, is also found to exist in plants. The animal 
organism, then, gives to blood only its form, it does not create it from other 
substances, which do not contain its constituents. It produces new com- 
pounds from the constituents, differing from them in composition, but the 
constituents themselves it cannot produce. In the section on the nutrition 
of carnivora, Liebig enters more into detail, as it exhibits the process in the 
two great classes of animals in a manner more readily understood. On 
examining the substances expelled from the adult serpent, after devouring 
a rabbit, goat, or bird, we find that the horns, hoofs, hair, feathers, and bones 
pass unchanged, that they are dry, and all parts capable of solution are ab- 
sorbed. It is to be observed, also, that when the serpent has regained its 
original weight, all other parts of the prey have disappeared. The only 
excrement is that from the urine, which, when dry, affords urate of ammo- 
nia; in it, for every equivalent of nitrogen there are two equivalents of car- 
bon. But, in the muscular fibre, blood, membranes, and skin, consumed, 
the amount of carbon is eight to one of nitrogen, and, if we have regard 
to the fat and nervous substance, even more. Now, if the urate of am- 
monia expelled contained all the nitrogen of the animal, at least six equi- 

150 Review, [Jan. 

valents of carbon, combined with it, must have escaped through the skin 
and lungs as oxidized products, as carbonic acid and water. Had the ani- 
mal food been burned, the same results would have followed, but more 
slowly. The nitrogen would have appeared with a part of the carbon and 
hydrogen as carbonate of ammonia, and the remaining carbon and hydro- 
gen would have been given off, as in the animal, in the form of carbonic 
acid and water, while the ashes and soot would represent the incombusti- 
ble and imperfectly burned parts of the food. We must not, however, 
suppose that the oxidized products are given off directly from the food con- 
sumed; this would imply that the only object in taking food was their pro- 
duction. The object of food is the restoration of the waste of matter. 
Certain parts of organs have lost their vitality — have been metamorphosed 
into amorphous and unorganized combinations, and these are expelled. 
Exactly as much carbon and nitrogen are supplied by the blood, and, con- 
sequently, by the food, as is lost by the waste of matter attendant on the 
exercise of the functions of the organs. Whenever a portion of matter is 
thrown off by the tissues, it is immediately carried away by the blood to- 
ward the heart. 

" These compounds cannot be employed for the reproduction of those tissues 
from which they are derived. They pass through the absorbent and lymphatic 
vessels into the veins, where their accumulation would speedily put a stop to the 
nutritive process, were it not that the accumulation is prevented by two contri- 
vances adapted expressly to this purpose, and which may be compared to filter- 
ing machines. The venous blood, before reaching the heart, is made to pass 
through the liver; the arterial blood, on the other hand, passes through the kid- 
neys; and these organs separate from both all substances incapable of contribut- 
ing to nutrition. Those new compounds which contain the nitrogen of the trans- 
formed orgrans are collected in the urinary bladder, and being utterly incapable 
of any further application in the system, are expelled from the body. Those, 
again, which contain the carbon of the transformed tissues, are collected in the 
gall-bladder, in the form of a compound of soda, the bile, which is miscible in 
water in every proportion, and which, passing into the duodenum, mixes with 
the chyme. All those parts of the bile which, during the digestive process, do 
not lose their solubility, return during that process into the circulation, in the 
state of extreme division. The soda of the bile, and those highly carbonized 
portions which are not precipitated by a weak acid (together making ninety-nine- 
hundredths of the solid contents of the bile), retain the capacity of resorption 
by the absorbents of the large and small intestines; nay, this capacity has been 
directly proved by the administration of enemata containing bile, the whole of 
the bile disappearing with the injected fluid in the rectum. Thus we know with 
certainty, that the nitrogenized compounds produced by the metamorphosis of 
organized tissues, after being separated from the arterial blood by means of the 
kidneys, are expelled from the body as utterly incapable of further alteration, 
while the compounds rich in carbon, derived from the same source, return into 
the system of carnivorous animals." — P. 58. 

The oxygen, conveyed by the blood to the different parts of the body, 
meets with the compounds produced by the transformed tissues and unites 
with their carbon and hydrogen, forming carbonic acid and water. All 
that in this way does not suffer oxidation, is sent back into the circulation 
as bile, and gradually disappears. Hence as all the carbon of the tissues, 
and all the carbon of the bile, disappears in one of the forms just mention- 
ed, through the skin and lungs, it follows that the elements of the bile serve 
for respiration and the production of animal heat. "If the excrements of 
a carnivorous animal be treated with water it will extract from them no bile, 

1843.] Liebig's Animal Chemistry. 151 

although it is extremely soluble and mixes in every proportion with it. 
The bile then is all consumed in the animal body." The view here taken 
of the uses of the bile, and the fact stated that no bile exists in the excre- 
ments, are entirely at variance with the generally received opinions of phy- 
siologists. It is well known that when the ductus choledochus is tied, con- 
stipation takes place, and the feeces change colour. One of the latest 
authorities in physiology assures us that there can be no question, that by 
far the largest portion is destined to be entirely thrown off, and it would 
seem from the character of its proximate elements, as if it were destined 
to remove from the blood its superfluous hydro-carbon, whether this have 
been absorbed as such from the aliment, or have been taken up by the 
blood as effete matter, during the course of the circulation. Bostock taught, 
that various pathological considerations would induce us to regard the bile 
as essentially an excrementitious substance, although in conformity with 
other operations in the animal economy, it is probable that some other pur- 
poses are served by it. It is a question worthy of consideration, whether 
the elements of the bile ma}^ not be combined in a different way, as in the 
case of cholic, choleic, and choloidic acid, the combined elements of which 
make up the bile, and thus escape detection in the fgeces. The origin of 
the bile and urine are evidently from the transformed tissues, since the 
secretion goes on while the animal is deprived of food, and during the 
winter sleep of those that hybernate. The urine is also evidently increased 
by exercise which increases the amount of metamorphosed tissue. In the 
adult carnivora, since it neither gains nor loses weight from day to day, the 
nourishment and waste of tissues must be equal. In the young of the 
same class of animals the weight increases; here, we must suppose the 
process of assimilation is more active tlian that of transformation. But 
the consumption of oxygen is greater, bulk for bulk, than in the adult; 
the motion of the blood also is more rapid, the substance of its organized 
parts would, therefore, undergo a more rapid consumption and yield to the 
action of oxygen, if the carbon and hydrogen were not supplied from 
another source; this source is found in the milk of the mother. The car- 
bon and hydrogen of the butter, and the carbon of the sugar of milk, are 
consumed in the respiratory process and given out as carbonic acid and 
water. It is in consequence of these substances, which have no other 
office than to prevent the action of oxygen, that growth takes place. It is 
not, however, from their assimilation that increase ensues, for they contain 
no nitrogen. The substance which is assimilated and becomes a part of 
the living tissue, is the caseine of the milk, which analysis shows to be 
identical with fibrine and albumen. To convert it into blood no foreign 
substance is required. It is also found to contain a much larger proportion 
of the earth of bones, than that fluid, in a soluble form in which it can 
reach every part of the growing body. 

The graminivora, during their whole life, depend on substances hav- 
ing a composition identical with, or closely resembling sugar of milk. 
Everything consumed by them as aliment contains starch, suD;ar, or gum. 
The first named substance, starch, is the most widely extended, and, as is 
well known, maybe converted into a kind of sugar, known as grape sugar, 
either by the process of germination, or by strong acids. This change 
depends, according to analysis, upon the addition of the elements of water; 
no carbon is separated, and nothing added, but the oxvgen and iiydrogen. 
A close connection thus exists between suofar and starch. Another kind of 

152 Review. [Jan. 

sugar, sugar of milk, also resembles starch; it is incapable of the vinous 
fermentation by itself, but, when heated with a substance in a state of pu- 
trefaction, will resolve into carbonic acid and alcohol. Gum, the third sub- 
stance mentioned, has the same composition as cane sugar, but, unlike 
sugar of milk, does not resolve itself into carbonic acid and alcohol when 
placed in similar circumstances. For the same number of equivalents of 
carbon 12, the number of equivalents of water will be in starch 10, cane 
sugar and gum 11, sugar of milk 12, grape sugar 14. 

The part performed by the substances above mentioned, in the vital pro- 
cess of the graminivora, is very similar to that performed by the butter 
and sugar of milk of the young carnivora. The amount of carbon con- 
sumed by the graminivora in the nitrogenized constituents of food is ex- 
ceedingly small, when compared with the oxygen absorbed by the lungs 
and skin. Tlie horse, which can be maintained in good condition on 15 
lbs. of hay and 4^ lbs. of oats daily, obtains from this amount of food 
but Ah oz. of nitrogen, and 14^ oz. of carbon; of this last only about 
8 oz. can be consumed in respiration, since, with the nitrogen expelled in 
the urine, there are 3 oz. combined as urea, and 3^ oz. of hippuric acid. 
But, according to the observations of Boussingault, a horse expires about 
79 oz. of carbon daily. He receives then about one-fifth of what is re- 
quired for the respiratory process. The remaining four-fifths must be sup- 
plied in other substances, or his organism will be destroyed by the action 
of the oxygen; this supply is found in the sua-ar, gum, and starch. If we 
apply the principle here set forth, to the nourishment of man, we shall see 
that a very close connection exists between agriculture and the multiplica- 
tion of the human species. A nation of hunters obtain the carbon for 
respiration from the flesh and blood of animals, which take the place of 
starch and sugar. But it is proved by chemical analysis, that 13 lbs. of 
flesh, contain no more carbon than 4 lbs. of starch; hence, an individual 
with one animal and an equal weight of staicli, could maintain life five 
times the number of days that he could if confined to the same weight of 
flesh alone. 

"Man, when confined to animal food, respires, like the carnivora, at the ex- 
pense of the matters produced by the metamorphosis of organized tissues; and, 
just as the lion, tiger, hyena, in the cages of a menagerie, are compelled to 
accelerate the waste of the organized tissues by incessant motion, in order to 
furnish the matter necessary for respiration; so, the savage, for the very same 
object, is forced to make the most laborious exertions, and go through a vast 
amount of muscular exercise. He is compelled to consume force merely in order 
to supply matter for respiration." — P. 75. 

Cultivation has for its object the production of a maximum of the sub- 
stances, but suited for assimilation and respiration, in the smallest possible 
space. When this is accomplished no such waste of motion will be re- 
quired to obtain the means of respiration as has just been mentioned. 
Cultivation economizes both force and nutriment. 

In comparing the urine of the carnivora with that of the graminivora, it 
is obvious, that transformation of tissue difl"ers both in form and rapidity, 
in the two classes of animals. Tlie urine of the carnivora contains phos- 
phates and sulphates; since the fluids contain only traces of these sub- 
stances, and since all tlie tissues, except cellular tissues, and membranes, 
contain phosphoric acid and sulphur, they must be derived from the tissues. 
In the graminivora, on the other hand, we find alkaline carbonates in abun- 


1843.] L\eh\'r''s Animal Chemistry. 153 

dance, but a very small proportion of alkaline phosphates; whence we infer 
that the tissues which supply these last are very slowly transformed. 

Turning to the assimilative process, we find it exhibiting a very marked 
difference in the two classes. Carnivorous animals devour their prey only 
when urged by hunger. They require less food for their support, because 
their skins have no respiratory pores, and, consequently, they lose less 
heat than the graminivora. These last eat almost without interruption 
through the day; their system has the power of converting into organized 
tissue all the food devoured, beyond what is required to repair the waste of 
the organism; consequently, they become plump while the flesh of the car- 
nivora is tough and sinewy. It is well known that animals become fat, in 
which the process of cooling and exhalation are diminished by preventing 
motion. This occurs in consequence of the absorption of less oxygen, 
than is required to convert all the carbon of the substances destined for 
respiration into carbonic acid. The excess of carbon, with the exception 
of a small portion expelled from the body in the form of hippuric acid, is 
employed in the production of fat. Hence, it is evident, that the forma- 
tion of this substance, depends upon the want of due proportion between 
the food and the oxygen. This proportion can be varied in another way, 
by providing for the carnivorous animal, for instance, food containing no 
nitrogen, such as gum, starch, sugar. According to the analysis of Chev- 
reul, human fiit, mutton fat, and hog's lard, contain the same relative pro- 
portion of carbon and hydrogen, as sugar, gum, and starch; these last can 
be converted into a substance having exactly the composition of the former 
by a separation of a portion of their oxygen. Consequently, a very re- 
markable connection exists between the formation of fat and the respiratory 
process. The oxygen, set free in the formation of fat, is given out in com- 
bination with carbon or hydrogen; tliese must have generated, in the forma- 
tion of carbonic acid and water, as much heat as would have been produced 
by burning the carbon and hydrogen in oxygen gas. 

We have seen, in what precedes, that no nitrogenized compound, the 
composition of which differs from that of fibrine, albumen, and caseine, is 
capable of supporting life. Animals can form from their blood all parts of 
their bodies, but all the materials must exist in the blood ready prepared, 
in every thing but the form. It is in consequence of the difference of com- 
position between fibrine and albumen, and gelatine, that the last cannot be 
used for a vital process. It is true that a small portion of this substance 
must exist in the blood, but the demand for it in the system is small, since, 
in a starving or sick individual, we find that the tendons and those parts 
which are held together by the gelatinous tissues, still retain their con- 
nections, even after the fat disappears, and the muscular tissue takes the 
form of blood. Experience, however, proves that to the diseased, gela- 
tinous substances are useful as a means of nourishment. It is not improba- 
ble that it is dissolved in the stomach, and forms a part of the blood, 
repairing the waste of tissues similar to itself, and saving the weakened 
vital powers the labour of forming it from the albumen, fibrine, or caseine. 
The experience of the Committee on Gelatine, appointed by the French 
Academy, has decided conclusively, that this substance capnot support life 
when used as the only food. 

Metamorphosis of Tissues. — The second part of the report is upon the 
metamorphosis of the tissues. The mode in which these parts are formed 
from the constituents of the blood is pointed out, and the changes they un- 

1 54 Revieiu. [Jan. 

dergo before being eliminated from the body. It is well known to chemists 
that ma!iy compounds exist, both nitrogenizedand non-nitrogenized, which, 
with the same composition in one hundred parts, offer very different ex- 
ternal characters. A group of three exists in the case of albumen, fibrine, 
and caseine. They contain the same proportion of organic elements, 
although differing in external characters. When either of these substances 
is dissolved in a solution of potash, and exposed to a high temperature, it 
is decomposed; if now to this solution acetic acid be added, a gelatinous 
translucent precipitate is formed, which is precisely the same in character 
and composition, from whichever of the three it is formed. Further than 
this, it is found that the precipitate contains the same organic elements, 
and in exactly tlie same proportion, as the animal matters from which it is 
prepared. This substance has been called by Mulder, the discoverer, 
proteine. The chief constituent of the blood and the caseine of milk, may 
be regarded as compounds of phosphates and other salts, and of sulphur 
and phosphorus, with a compound of carbon, nitrogen, hydrogen, and 
oxygen, ni which their relative proportion are invariable. Viewed in this 
light, proteine is the commencement of the tissues, because these are all 
produced from the blood. It has also been ascertained that vegetable 
fibrine, caseine, and albumen, treated like the same animal substances, also 
yield proteine; hence vegetables are the producers of all the proteine, 
which, when developed by the vital force, and the influence of oxygen and 
hydrogen, form all the organs and tissues of the animal body. To this we 
shall readily yield assent, when we consider the development of the chick 
in the egg. The egg contains no other nitrogenized compound except 
albumen; the yolk contains the same substance with the addition of a lit- 
tle fat, in which cholesterine and iron may be detected. Now, from these 
substances, with the addition of oxygen, all the various parts of the young 
fowl are formed. Hence albumen is the essential substance, and all nitro- 
genized articles of food, whether derived from the animal or vegetable 
kingdom, are first converted into this substance before they can become 
nourishment for animals. All food becomes soluble in the stomach and 
capable of entering into the blood. In this process of solution the oxygen 
of the air, and a fluid secreted by the stomach, are the only agents. The 
oxygen, Liebig supposes, to be introduced into the stomach by means of 
the saliva. This he considers peculiarly adapted for entangling the air 
in the form of froth, and conveying it with the food to the stomach, where 
the oxygen combines with the food, and the nitrogen escapes through the 
skin and lungs. An argument in favour of this supposition may be drawn 
from the fact, that the herbivora both swallow witli the saliva more air, 
and expire more nitrogen tlian the carnivora; they also expire more when 
taking food than when fasting. However this may be, it is certainly quite 
as plausible a theory as any which has been broached to account for this 
fluid; it certainly must perform some office in the digestive process, or it 
would not be secreted in so large a quantity, just at the time when the food 
is passing to the stomach. The process of digestion is so clearly, and, as 
it seems to us, so accurately described by our author, that we shall extract 
what he says upon the subject entire. 

"The most decisive experiments of physiologists have shown, that the pro- 
cess of chymification is independent of the vital force; that it takes place in 
virtue of a purely chemical action, exactly similar to those processes of decom- 
position or transformation which are known as putrefaction, fermentation, or 

1843.] Liebig's Animal Chemistry. 155 

decay, (eremacausis). When expressed in the simplest form, fermentation or 
putrefaction may be described as a process of transformation,— that is a new 
arrang-ement of the elementary particles, or atoms, of a compound, yielding two 
or more new groups or compounds, and caused by contact with other substances, 
the elementary particles of which are themselves in a state of transformation or 
decomposition. It is a communication, or an imparting of a state of motion, 
which the atoms of a body in a state of motion are capable of producing in other 
bodies, whose elementary particles are held together only by a feeble attraction. 
Thus the clear gastric juice contains a substance in a state of transformation, by 
the contact of which with those constituents of the food, which, by themselves, 
are insoluble in water, the latter acquire, in virtue of a new grouping of their 
atoms, the property of dissolving in that fluid. During digestion, the gastric 
juice, when separated, is found to contain a free mineral acid, the presence of 
which checks all further change. That the food is rendered soluble quite inde- 
pendently of the vitality of the digestive organs, has been proved by a num- 
ber of the most beautiful experiments. Food enclosed in perforated metallic 
tubes, so that it could not come into contact with the stomach, was found 
to disappear as rapidly, and to be as perfectly digested as if the covering- 
had been absent; and fresh gastric juice out of the body, when boiled white of 
^g^i or muscular fibre, were kept in contact with it for a time at the temperature 
of the body, caused these substances to lose the solid form and to dissolve in 
the liquid. It can hardly be doubted that the substance, which is present in the 
gastric juice in a state of change, is a product of the transformation of the 
stomach itself. No substances possess, in so high a degree as those arising 
from the progressive decomposition of the tissues containing gelatine or chon- 
drine, the property of exciting a change in the arrangement of the elements of 
other compounds. When the lining membrane of the stomach of any animal, 
as, for example, that of the calf, is cleaned by continued washing with water, it 
produces no effect whatever, if brought into contact with a solution of sugar, 
with milk, or other substances. But if the same membrane be exposed for some 
time to the air, or dried, and then placed in contact with such substances, the 
sugar is changed, according to the state of decomposition of the animal matter, 
either into lactic acid, into mannite and mucilage, or into alcohol or carbonic 
acid; while milk is instantly coagulated. An ordinary animal bladder retains, 
when dry, all its properties unchanged; but when exposed to air and moisture, 
it undergoes a change not indicated by any obvious external signs. If, in this 
state, it be placed in a solution of sugar of milk, that substance is quickly 
changed into lactic acid. The fresh lining membrane of the stomach of a calf, 
digested with muriatic acid, gives to this fluid no power of dissolving boiled flesh 
or coagulated white of egg. But if previously allowed to dry, or if left for a 
time in water, it then yields to water acidulated with muriatic acid, a substance 
in minute quantity, the decomposition of which is already commenced, and is 
completed in the solution. If coagulated albumen be placed in tl)is solution, 
the state of decomposition is communicated to it, first at the edges, which be- 
come translucent, pass into a mucilage, and finally dissolve. The same change 
gradually affects the whole mass, and at last it is entirely dissolved, with the ex- 
ception of fatty particles, which render the solution turbid. Oxygen is con- 
veyed to every part of the body by the arterial blood; moisture is everywhere 
present; and thus we have united the chief conditions of all transformations in 
the animal body." 

To some, perhaps, the idea suggested by the term eremacausis will be 
that of fermentation, similar to what takes place in sugar and animal sub- 
stances, and which is accompanied by the disengagement of gas. But it 
must be borne in mind that there are many cases of complete changes in 
the arrangement of the elements of a compound without the disengagement 
of any gas whatever. It is this last which bears a resemblance to the pro- 
cess of digestion. The fact that all substances which can arrest the phe- 

156 Review. [Jan. 

nomena of fermentation and putrefaction in liquids, also arrest digestion 
when taken into the stomach, adds not a little to the probability that the 
two processes are similar. The free acid found in the gastric juice is the 
muriatic. This acid is derived from common salt, which is an important 
agent hi converting fibrine and caseine into blood; its power of dissolving 
bone earth is remarkable, its action upon acetic acid is equal to that of 
lactic acid, consequently, the necessity formerly supposed for this last acid 
does not exist. Iron also has been found in the gastric juice, which un- 
doubtedly plays an important part in the formation of the blood. 

The formula for Proleine, which is the result of the best analyses ex- 
pressed in equivalents, is C. 48, H. 36, N. 6, O. 14; and this is also the 
relative proportion of the organic elements of the blood. Albumen and 
fibrine contain besides these elements sulphur and phosphorus, the former 
more sulphur than the latter; and caseine contains besides proteine, sul- 
phur. The state in which sulphur and phosphorus exist in these sub- 
stances is not well known, nor the exact quantity. From albumen and 
fibrine all the tissues of the body are formed in one of two ways, either, by 
the addition, or subtraction, of certain elements. As an example of the 
changes which may take place in the formation of the various organic sub- 
stances, the following table is given derived from the researches of Mulder 
and Scherer. In this table the phosphorus and sulphur are not given in 
equivalents, but in their relative proportions in the different tissues. 

Composition of Organic Tissues, 

Albumen . . . . C. 48, N. 6, H. 36, 0. 14+P+S. 

Fibrine . . . . . C. 48, N. 6, H. 36, O. 94+PH-2 S. 

Caseine . . . . C. 48, N. 6, H. 36, O. 14+S. 

Gelatinous tissues, tendons . C. 48, N. 75, H, 41, 0. 18. 

Chondrine . . . . C. 48, N. 6, H. 40, 0. 20. 

Hair, horn . . . . C. 48, N. 7, H. 39, O. 17. 

Arterial membrane . . C. 48, N. 6, H. 38, O. 16. 

From the table it appears, that when proteine passes inio chondrine, the 
elements of water have been added with oxygen, and, that for the same 
amount of carbon all the tissues contain more oxygen than the constituents 
of blood. In the gelatinous membranes, it is to be observed, nitrogen has 
been added as well as hydrogen, in the proportions to form ammonia. 
The production of the compounds derived from the blood may he explained 
in two ways. One is from albumen by the addition of oxygen, of the ele- 
ments of water, of those of ammonia, accompanied by the separation of 
sulphur, and phosphorus; the other from proteine by the separation of car- 
bon. Tlie last is the most probable. 

It is not a little remarkable that the true formula for the bile, and the 
key to its metamorphoses, under the influence of acids and alkalies, have 
been found by means of the view taken by Liebig in the transformation of 
the tissues. It is perfectly evident, that if the existing organs are derived 
from the blood and are continually undergoing change under the influence 
of oxygen in it, that the animal secretions must contain the products of this 
change in the organs. It has been stated that the bile contains the pro- 
ducts of transformation containing the most carbon, and the urine those 
containing the most nitrogen, consequently, the sum of these elements 
must make up the proportion of these same elements in the blood. If 
then we subtract from the elements of blood, those of urine and the oxygen 
and water, which were added during the transformation of the organs, we 

1843.] Liebig's Animal Chemistry, , 157 

shall have the bile; or, if we reverse the process we shall obtain the com- 
position of the urate of ammonia of the urine. The formula for blood 
and flesh, according to Playfair and Boeckman, is C. 48, N. 6, H. 39, 
O. 15. The chief constituent of the bile is choleic acid, and if we 
subtract from its elements the products formed by the action of muriatic 
acid, ammonia and taurine, we obtain the empirical formula for choloidic 
acid. If from the formula of choleic acid we subtract the elements of 
urea and two atoms of water we shall have the formula for cholic acid. 
So close is the coincidence between these formulae and actual analysis 
that there can be no doubt that the true formula of choleic acid has been 
obtained. If now to choleic acid, which we must recollect represents the 
constituents of the bile, we add the chemical equivalents of the neutral 
urate of ammonia, or the urine of serpents, we shall have a formula ex- 
pressing the composition of the blood with the addition of one equiva- 
lent of oxygen and one of water. And, again: if we add to the elements 
of proteine three equivalents of water we obtain exactly the same for- 
mula, with the exception of one equivalent of hydrogen, and this last is 
the only difference between the formula thus obtained and that given by 
adding the urate of ammonia to choleic acid. It seems to us that it is 
thus clearly demonstrated, that the metamorphosis of tissues takes place in 
the manner pointed out by Liebig, and that choleic acid with urate of am- 
monia are the results of this metamorphosis. The form of metamorphosis 
here indicated is that belonging to the lower classes of amphibia and per- 
haps to worms and insects. The disappearance of uric acid in the higher 
classes of animals and its replacement by urea depend upon the oxygen 
absorbed during respiration and the water consumed. In proof of this, it 
may be mentioned that in the mulberry calculi we find oxalate of lime, and 
in others urate of ammonia, and this always in persons who take so little 
exercise that the supply of oxygen has been diminished. Uric and oxalic 
acid calculi are not found in phthisical patients. The quantity of uric 
acid and urea depends in no degree upon the food, since a starving man 
labouring much secretes more urea than another freely nourished but re- 
maining at rest. The urine of the herbivora contains ammonia, urea and 
hippuric or benzoic acid, but no uric acid; the existence of benzoic or hip- 
puric acid depending upon the quantity of carbon, and consequendy upon 
the amount of motion. Animals that consume much water keep the uric 
acid, which is sparingly soluble, in a state of solution, whereby the oxygen 
readily acts upon it and transforms it into carbonic acid and urea. In 
birds, on the other hand, which drink but seldom, uric acid appears in the 
urine, notwithstanding the rapidity of respiration and increased supply of 
oxygen. In the foetal calf, the transformation of the tissues is effected 
through the blood of the mother, which affords the proteine. Here it ap- 
pears ihat two atoms of proteine with the addition of nothmg except two 
atoms of water, contain the elements of six atoms of allantoine and one 
atom of chloidic acid, or meconium. But allantoine contains the ele- 
ments of uric acid and urea; hence we see that the relation between the 
allantoine of the foetal calf and proteine, corresponds with that of the con- 
stituents of the urine in animals which breathe to their nourishment. 

We h ive spoken above of the origin of bile in the carnivora, but in the 
herbivora the quantity of the bile is often much too great to be afforded by 
the tissues themselves. It is ascertained, for example, that of 59 oz. of dry 
bile secreted by the ox, 2i oz. is nitrogen. Now, if this nitrogen pro- 
No. IX.— January, 1843. II 

1 58 Review. [Jan. 

ceeded from the metamorphosed tissues, and all their carbon passed into 
the bile, it would yield an amount of bile corresponding to 7.15 oz. only 
of carbon. Hence other substances must take part in the formation of bile, 
and these are the non-nitrogenized parts of the food, starch, sugar, gum, 
&:c. If, as has been stated by Ure, benzoic acid, when administered inter- 
nally, appears as hippuric acid in the urine, it would seem that the act of 
transformation of the tissues takes a new form with respect to the resulting 
products under the influence of matters used as food. It may be remarked 
that fat forms more rapidly when no salt is present in the food; and that a 
compound of sodium in some form is necessary for the production of bile. 
The presence of muriatic acid in the stomach, and soda in the blood, also 
go to show the importance of common salt in the organic processes. In 
the carnivorous animal, the soda in the blood, which is only what is neces- 
sary to form the blood, is sufficient to form bile with the products of the 
tissues; but in the herbivora, the quantity of bile is so great that it cannot 
be obtained otherwise than directly from the food; their organism must 
have the power of combining all the soda in the food directly in the bile. 
We cannot, therefore, consider the existence of alkalies in plants accidental, 
for besides finding them in the bile, their presence is indispensable for the 
production of the first food of the young animal; without potash, the pro- 
duction of milk would be impossible. 

From many facts we are warranted in the conclusion that there are sub- 
stances which, although they may not become parts of the tissues, are still 
capable of playing a part in certain vital processes; there are others which 
exercise an influence on the nutritive process and on transformation of tis- 
sues, although they take no part in the changes which ensue. There are 
always substances which have a power of communicating the change going 
on in their own particles to parts of the system capable of undergoing the 
same change. 

Another class of substances exists, consisting of the medicinal and poi- 
sonous compounds, the elements of which are capable of taking a direct 
or indirect share in the processes of secretion and transformation. Of these 
there are three kinds: first, those which unite chemically with the tissues 
or constituents of the body, the vital force being incapable of destroying 
the resulting compound. Secondly, those which impede or retard those 
combinations, called fermentation and putrefaction when taking place out 
of the body, to which certain complex organic molecules are liable. To 
this class belong essential oils, camphor, empyreumatic substances, and 
antiseptics. Thirdly, medicinal substances, the elements of which take a 
direct share in the changes going on in the animal body, although they are 
not nutritive, nor are they employed by the organism in the production of 
blood. They all produce a marked effect in a comparatively small dose, 
and many in a larger dose are poisonous. They are probably not decom- 
posed when taken into the stomach, but if insoluble are rendered soluble, 
that they may enter the circulation, and there alter the quality of the blood. 
As regards the modus operandi of this class of medicinal agents, we must 
conclude that their elements either take a share in the formation of certain 
constituents of the body, or in the production of certain secretions. One 
example of the influence of substances on the secretions has been given in 
that of starch on the secretion of bile in the herbivora. Our knowledge 
with regard to the composition of the different secretions, except that last 
mentioned, is limited; we do know, however, that all of them contain ni- 

1843.] Ij'xehxg^s ,Bnimal Chemistry. 159 

trogen chemically combined; they all yield ammoniacal products. It is to 
be noticed, that of the medicinal or remedial agents, those containing nitro- 
genized vegetable principles, whose composition differs from that of the 
nitrogenized elements of nutrition, are distinguished for their powerful ac- 
tion on the animal economy. These effects vary from the mildest form of 
the action of aloes to that of the most terrible poison, strychnia. No re- 
medy devoid of nitrogen possesses a poisonous action in a similar dose. 
The poisonous action, however, is not in proportion to the nitrogen, 
although it is not independent of it. Solanine and picrotoxine, which con- 
tain least, are powerful poisotis. In the substance last mentioned, the 
quantity of nitrogen is so small, that it had been overlooked, until, in con- 
sequence of the general law above mentioned, it was again examined and 
detected. Quinia contains more nitrogen than morphia. Caffeine and theo- 
bromine, the most active principles of coffee and the cacao-bean, the most 
highly nitrogenized of all vegetable substances, are not poisonous. 

The other nitrogenized vegetable principles, quinine, alkaloids of opium, 
&c., appear to act upon the brain and nervous system chiefly, and not, as 
those just mentioned, upon the secretions. They accelerate, retard, or 
alter, in some way, the phenomena of motion in animal life. The fact, 
that these substances are material, tangible and ponderable; that they 
disappear in the system; require repetition and increase of dose if we 
would repeat and increase the effect; lead us, when viewed chemically, to 
the supposition that their elements take a share in the formation or trans- 
formation of brain and nervous matter. 

" However strange the idea may, at first sitrht, appear, that the alkaloids of 
opium or of cinchona bark, the elements of codeine, morphia, quinine, &c., may 
be converted into constituents of brain and nervous matter, into organs of vital 
energy, from which the organic motions of the body derive their origin; that 
these substances form a constituent of that matter, by the removal of which the 
seat of intellectual life, of sensation and consciousness, is annihilated; it is 
nevertheless, certain, that all these forms of power and activity are most closely 
dependent, not only on the existence, but also on a certain quality, of the sub- 
stance of the brain, spinal marrow, and nerves; insom.uch that all the manifesta- 
tions of the life or vital energy of these modifications of nervous matter, which 
are recognised as the phenomena of motion, sensation, or feeling, assume another 
form as soon as their composition is altered." — P. 173. 

The animal organism has produced the substance of the brain and nerves 
from vegetable principles, entering into the formation of proteine, either 
alone, or, aided by the elements of non-azotized food, or the fat formed 
from it; consequently, it isnot impiobable that other vegetable constituents, 
intermediate between the fat and compounds of proteine, may also be ap- 
propriated by the organism. It may give us some hint as to the mode of 
action of these substances, to know that cerebric acid, the peculiar acid of 
the fat of the brain, approaches more nearly in its composition to choleic 
acid than any other. Brain and uervous matter is, certainly, formed, 
either by the separation of a highly azotized compound from the elements 
of the blood, or by the combination of an azotized product of the vital pro- 
cess with a non-azotized compound, and that, probably, a fatty body. 
There can be no manner of doubt, that the production of nervous matter 
from blood requires a change in the composition and qualities of the con- 
stituents of the blood. The compound of proteine may form a first, 
y, second, or third, &c., product before it becomes nervous matter, and if a 
vegetable principle be introduced into the blood, it may supply the place 
of any one of these products, if its composition is properly adapted for it. 

160 Review, [Jan. 

Another, and important fact is, that the vegetable alkaloids cannot be 
shown to be related, in composition, to any other constituent of the body, 
except the brain and nerves, all of which contain nitrogen, and in composi- 
tion are intermediate between proteine and fat. The brain itself exhibits 
the character of an acid; those substances which act powerfully upon the 
nervous centres, morphia, strychnia, and other alkaloids, are arranged in 
point of activity in the inverse order of the proportions of oxygen they 
contain, evidently pointing out a striking fact as to the nature of their 
action. We have seen that ready-formed gelatine may be appropriated by 
the sick, and the system relieved of the task of preparing it from the blood; 
in a similar way, it may be supposed, a product of vegetable life may be 
employed by the organism for the same purpose as that formed by the 
vital energy. 

By late analyses it has been found that the peculiar vegetable principles 
in coffee and lea, caffeine and tfieine, are identical in composition. It is 
remarkable also, that this substance, with the addition of oxygen and the 
elements of water, yield taurine^ the nitrogenized principle of bile. The 
same is true of the principle of asparagus. If to the elements of theobromine 
the same constituents be added, we have the elements of taurine combined 
either with urea, carbonic acid and ammonia, or uric acid. It is in virtue 
of the nitrogen they contain that these substances assist in forming the 
azotized constituents of the bile. It cannot be denied that such aid may 
be required where there is a deficiency of motion, and, consequently, a 
deficiency of that change of tissue which would yield a nitrogenized pro- 
duct for the composition of the bile, and where, also, the non-nitrogenized 
food is in excess. In such cases, this principle in the food may supply 
the place of the product derived from the tissues, and consumed in the 
respiratory process. 

Phenomena of Motion in the Jinimal Organism. — The consideration 
of motion in animals, constitutes the third part of our author's report. It 
is introduced by remarks on vitality, and a comparison of its phenomena 
with other natural phenomena, the laws governing which have been inves- 
tigated. We have included in our analysis of the first part of this work, 
the principal facts and observations which introduce the subject of motion; 
we shall, therefore, omit all that may not be necessary for the explanation 
of Liebig's views on this subject. To aid us in forming a clear conception 
of the origin of the mechanical motions in the animal body, recourse 
may be had to the various wonderful effects of the galvanic battery. When 
the two kind of plates are brought in contact with an acid and united by a 
wire, a chemical action begins at the surface of the most oxidizable plate, 
and the wire acquires certain properties, overcomes resistance, and decom- 
poses compounds, the elements of which have the strongest attraction for 
each other; yet this wire lakes no part in these changes, it is merely the 
conductor of force. The manifestations of this force follow immediately 
upon the change in the chemical character of the acid, and the amount of 
force is in dirtct proportion to the number of particles of acid undergoing 
this change. Applying these facts to the investigation of motion in the ani- 
mal body, we know that the heart and some other organs do not generate 
moving power in themselves, but receive it from other parts; we know that 
the nerves are the conductors of force and motion; that where nerves are 
not found motion does not occur. The excess of force in one organ is 
carried to other parts which cannot produce it. The motions of the animal 

1843.] Liehig's Animal Chemistry, 161 

organism are dependent upon a certain change of form and structure in the 
living part, and the amount of this change stands in a close relation with 
the amount of force consumed in the motions. Immediately on the mani- 
festation of mechanical force, a portion of the muscle acting, unites with 
oxygen, loses its vital properties and separates from the living parts. 
From this relation between change of matter and consumption of force 
Liebig infers 'Hhat the active or available vital force in certain living parts 
is the cause of the mechanical phenomena in the animal organism." The 
whole of this part of the report is devoted to the support of this proposi- 
tion. It cannot be denied, whatever may be the theory, that for any amount 
of motion an equivalent of chemical force is manifested, that is an equiva- 
lent of oxygen enters into the substance of the organ which has lost its 
vitality. We see, too, that all parts destined for the production of force 
are traversed in all directions by minute vessels, in which arterial blood 
continually circulates, carrying a free supply of oxygen. That these are 
facts we cannot doubt, although we may well doubt whether the cause of 
the combination of the oxygen with the muscle is, that the nerves have 
conducted away that which resists the oxygen, the vital force. Our au- 
thor supposes that the nerves do this, in their office of conductors. In 
accordance with this view, he finds the muscular system interwoven with 
nerves, while the gelatinous tissues, mucous membranes, tendons, &c. not 
destined to produce mechanical force, are destitute of them. These last 
mentioned substances have a composition which would readily allow of 
their combination with oxygen; one surface of the intestines and the cells 
of the lungs is constantly exposed to its action, and would undergo change, 
were it not that other more easily oxidizable substances are present and 
neutralize it. In this point of view we cannot fail to perceive the import- 
ance of the bile to the intestines and pulmonary cells, as well as of the fat, 
mucus, and secretions generally. The bile, it will be recollected, is afford- 
ed by metamorphosed muscular tissue; hence the greater the amount of 
force expended, the greater the amount of bile to protect these surfaces. 

We cannot question that the blood is continually bathing the various 
parts with their nourishment, and that the living muscular tissue never 
loses its power of growth; but the force expended, and consequently, the 
waste of matter is continually varying; it is also obvious that an equilibrium 
between supply and waste can only occur when the lifeless portion removed 
is, at the same instant, supplied by a new portion. Orowth takes place to 
about the same extent in equal times. Mechanical effects on the other hand 
vary greatly in amount during the same time. Now as we can hardly sup- 
pose that supply and waste occur at the same instant, there must be in 
every individual, unless the phenomena of motion are to cease entirely, a 
condition in which all voluntary motions are completely checked, in which 
there is no waste. This condition is sleep. The involuntary motions con- 
tinue during sleep, but the amount of force required, and consequently of 
tissue which loses its life, is confined within narrow limits; but this force, 
whatever it may be, and that expended in voluntary motions, during the 
waking state, must be reaccumulated during sleep. In this state, voluntary 
motion ceasing, the animal approaches to the nature of a plant, in which all 
its vital energy is employed in growth and nutrition. The living part of a 
plant acquires, according to Liebig, its whole vital force from the absence 
of conductors of force. By this means the leaf is enabled to overcome the 
strongest chemical attractions. The same vital force which in the plant is 

162 Revieiv. [Jan. 

an almost unlimited capacity of growth, becomes in the animal body, a 
source of motion. A wonderful and wise economy has ordained, that what 
is appropriated as nourisiiment slioidd have a composition identical with 
that of muscular tissue. If animals were obliged to decompose carbonic 
acid, the elements of which are held together with such force, much vital 
energy would be prevented from assuming the form of moving power. The 
change of blood into muscular fibre, may take place without loss of force, 
since it is a mere change of form from a fluid to a solid; all the constitu- 
ents of the latter floating in the former. 

"In what form, or in what manner, vital force produces mechanical effects in 
the animal body, is altogether unknown, and is as little to be ascertained by ex- 
periment, as the connection of chemical action with the pnenomena of motion, 
which we can produce with the galvanic battery." 

We see then that growth stands in a fixed relation to the amount of 
vital force consumed as a moving power; that the power available for me- 
chanical forces is equal to the amount of vital force in the tissues which 
may undergo change, and that in a given time only a limited amount of 
force can be manifested. The amount of azotized food, necessary to re- 
store the balance between waste and supply of matter, is in proportion to 
the tissues metamorphosed, and the last may be measured by the amount 
of nitrogen in the urine. Hence we learn that, in whatever way mechani- 
cal force has been employed, whether in voluntary or involuntary motions, 
it must be proportional to the amount of nitrogen in the urine. Health 
in the adult, must include the idea of equilibrium among- all the causes of 
waste and supply, the absolute amount of which is different at different 
periods of life. In the child nutrition is active, and the supply exceeds 
the waste; but as the vital force cannot be employed at the same time in 
increasing the mass, and in producing mechanical effects, these last must 
be less than in the adult. In old age, on the other hand, as the mechani- 
cal effects have increased, growth ceases, and the whole mass even de- 
creases. The available power is estimated by mechanics to be, in the 
adult, jth the weight of his own body, moved during eight hours at the 
rate of five feet in two seconds. In regaining his original weight, a man 
regains a sum of force which enables him to repeat the next day the same 
amount of labour. In seven hours of sleep this amount of force is ob- 
tained, consequenUy we may assume that the mechanical power is in pro- 
portion to the number of hours of sleep. The adult man wakes 17 hours 
and sleeps 7; if the equilibrim is restored in 24 hours, the mechanical 
effects produced in the waking state, must be equal to the effects produced 
during 7 hours in the formation of new parts. An old man sleeps 3| 
hours, and all other things being equal, he will be able to produce half 
the mechanical effects of the adult of equal weight. The infant sleeps 20 
hours and wakes only 4, hence the force consumed in forming new parts 
is to the force used in motion as 20 to 4. If we represent the available 
force of the adult man by 100, and consider this equal to the formative 
power, the same forces will be represented in the child by 24 and 286, in 
the old man by 118 and 43; the proportion of increase of mass to the 
waste, will be in the adult as 100 : 100, in the child as 100 : 9, and in the 
old man as 100 to 274. With every hour of sleep the sum of available 
force in the old man approaches the state of equilibrium between waste 
and supply, which exists in the adult. 

The living animal body manifests these effects only at certain tempera- 

1843.] Liebig's Animal Chemistry, 1^ 

tures. The abstraction of heat is equivalent to a diminution of vital 
energy. The cooling process is counteracted by the combination of 
oxygen with the metamorphosed tissues in the carnivora; in the herbivora 
a certain amount of heat is generated by those elements of their non-azo- 
tized food which can combine with the same gas. The food required by 
.the same individual exposed to different temperatures is unequal, more 
being consumed in the lower than in the higher temperature, and as the 
original weight remains the same, it follows that the oxygen absorbed must 
also be greater in the lower. The amount of tissue metamorphosed being 
thus augmented, shows that a greater amount of vital force must be ren- 
dered available for mechanical purposes. With the external cooling, the 
respiratory motions become stronger, and more oxygen is conveyed to the 
blood; but in a given time an unlimited supply of oxygen cannot be intro- 
duced into the body, consequendy it is only within certain limits that the 
diminished temperature increases the transformation of tissue. If the 
cooling go beyond a certain point the temperature of the body falls, the 
mechanical effects diminish, and a state of sleep ensues, in which all in- 
voluntary motions soon cease, and death takes place. In climbing high 
mountains, where the air is rarified, and less oxygen absorbed in an equal 
number of respirations, the amount of force available for moving the body 
diminishes. If any substance be introduced into the system, for which 
oxygen has a greater affinity than for the animal tissues, these last will be 
preserved and a limit put to the change of matter in certain parts of the 
body. Liebig supposes alcohol to supply the place of muscular fibre in 
combining with oxygen, and remarks that the development of heat in the 
body after its use, is not accompanied by a corresponding amount of me- 
chanical force. That alcohol is consumed within the body, he infers from 
the fact that it has never been chemically detected either in the expired 
air, urine, or perspiration, although the weariness, feebleness of limb, and 
drowsiness, show that the mechanical force is diminished, still we cannot 
question that some of these symptoms must be attributed to the influence 
of alcohol on the nerves of voluntary motion. 

In hybernating animals, during their winter sleep, there is no increase 
of mass; in some, apparent death occurs in consequence of the diminished 
vital energy; in others the involuntary motions continue, and preserve a 
temperature above that of the surrounding air. The respirations go on, 
and the oxygen unites with the fat, covering all those organs which would 
not otherwise be able to resist its decomposing influence, and which, like 
the intestines and membranes, are not destined for the change of matter. 
In this class of animals the active force of the living parts is devoted, 
during hybernation, to carrying on the involuntary motions; no expen- 
diture taking place in voluntary motion. In animals which have been 
hunted to death, metamorphosis of all the living parts of its muscular 
system occurs, and its flesh becomes uneatable. AH the available vital 
force is consumed in voluntary motion, leaving nothing for those that are 
involuntary, and a fatal syncope follows. 

Theory of Respiration. — During the passage of the venous blood 
through the lungs, the globules change colour and absorb oxygen, and for 
each volume of oxygen absorbed, an equal volume of carbonic acid is 
given out. The red globules contain a compound of iron, and no other 
constituent of the body contains iron. It is to the part which iron plays 
in the respiratory process, that Liebig directs his attention. The globules 

164 Review. [Jan. 

which have lost their oxygen by combining with the various tissues of the 
body, in their return towards the heart, combine with carbonic acid and 
produce venous bk^od; and when they reach the lungs an exchange takes 
place between this carbonic acid and the oxygen of the atmosphere. The 
iron in the arterial blood exists in the state of a peroxide, it passes to the 
capillaries, gives up a portion of its oxygen and becomes a protoxide, it 
then combines with carbonic acid and returns to the heart as a carbonate; 
in the lungs it is again exposed to atmospheric air, becomes again a 
peroxide and returns to the tissues. This hypothesis rests on well known 
observations, and Liebig proves by calculation that the amount of iron pre- 
sent in the blood is sufficient for transporting twice as much carbonic acid 
as can be formed by the oxygen absorbed in the lungs. This hypothesis 
explains the frightful effects of sulphuretted hydrogen and prussic acid, 
when inspired, by the well known action of these compounds on those of 
iron, when alkalies are present; and free alkali is never absent in the 

All the analytical evidence referred to in the body of the work, is col- 
lected in the appendix. It is copious and contains many valuable analyses, 
some of them undertaken expressly for this work. The analyses of food 
and of the constituents of the blood are especially full. 

In conclusion, we would express our obligation to Professor Webster, 
for the opportunity he has given us, in his handsome and accurate Ameri- 
can edition, of becoming acquainted with so valuable a contribution ta 
chemistry and physiology. 

1843.] 165 


Art. XIII. The History, Diagnosis, and Treatment of Typhoid and of Typhus 
Fever; with an Essay on the Diagnosis of Bilious Remittent and <f Yellow 
Fever. By Elisha Bartlett, M. D., Professor of the Theory and Practice 
of Medicine in Transylvania University. Philadelphia, Lea and Blanchard, 
1842. pp. 395. 

The above work was written, as the author informs us, in view of a want in 
medical literature, which we agree with him it was important to supply. This 
want mainly arises from two sources. One is, to use the v^ords of Dr. B.,that 
our science, so far as the great subject of idiopathic fevers is concerned, is pass- 
ing through a transition period; and hence many authorities, recently received 
as standard and classical, are fast becoming obsolete. Again, it is every day 
becoming more apparent to all, that the English writers on fever must be re- 
garded as insufficient and unsafe guides to tlie American practitioner on the sub- 
ject of fever, because the descriptions of the former are principally derived from 
the observation of a form of fever rarely met with amongst us. This difficulty 
is further increased by the fact that they have failed to discriminate sufficiently 
this form of continued fever from that which is most common in this country, 
and to which the terra typhoid is now generally applied. To lay before the 
reader, then, a fuller and more discriminating history of the two principal forms 
of continued fever is the chief object of our author. His book aims, he tells us, 
at no other excellence and no higher merit, than those of being a methodical and 
compendious summary of the actual state of our knowledge upon two most com- 
mon and most important diseases. This excellence, it seems to us, that it has 
attained in a high degree, for we have rarely met with a work which so faithfully 
satisfied the promises of the preface as that before us. The third and last part 
of the work consists of a short essay on the diagnosis of bilious remittent and 
yellow fevers. 

Typhoid fever is first described. With this disease, our author has had op- 
portunities of becoming practically familiar, his professional life hitherto having 
been passed in a portion of New England, where the disease has very constantly 
and at times very extensively prevailed. For this reason, and because it has 
been better studied, and, there is good reason to think, is more generally and 
extensively prevalent in various parts of the world than the other distinct forms 
of essential or idiopathic fever, the first place is assigned to it. That it is very 
generally prevalent in many parts of the world cannot be doubted, but whether 
in this respect as well as in the number of persons attacked it exceeds in im- 
portance malarious fevers, we very much question. Of the wide prevalence of 
the former, however, there is no question, and it is equally well understood that 
as it prevails with us it is entirely identical with that of Paris so ably described 
by Louis and Chomel. Its description by these gentlemen constitutes the basis 
of that before us, in which are incorporated the observations of Jackson, Hale 
and others in this country, together with the author's own experience. He has 
also made use of the admirable essay of Nathan Smith, written before the patho- 
logical characters and diagnosis of the disease had received their present degree 
of elucidation, upon the typhus fever of New England, of the identity of which 
with that now known as typhoid, there can be no question. 

We shall not of course follow our author in his description, in which he has 
taken up each symptom, lesion, &c. in succession, after the example of Louis 
and others. 

166 ^ Bibliographical Notices. [Jan, 

In reference to the contagiousness of the disease he expresses no opinion, as 
further and more various observations are necessary to settle the question. He 
lays before the reader the statements of the best authorities, particularly adduc- 
ing' that of Dr. Smith in this country, who, in common with Gendron and others 
in France, believe in its contagious character, and adduce in support of their 
opinion many instances of its introduction and spread in country villages in such 
manner as to render the influence of contagion highly probable. The facts 
stated by Dr. Smith are certainly very strong, and the immunity from a second 
attack, a point which now seems to be pretty well established, does certainly, 
as our author remarks, strongly corroborate the same view. 

Speaking of the influence of locality, he says: — 

" Typhoid fever is, evidently, a disease of very extensive geographical preva- 
lence. We have not the means of ascertaining its limits, but there is good 
ground, I think, for believing, that these limits are wider than those which cir- 
cumscribe, the prevalence of any other strictly idiopathic, non-eruptive fever. 
It is the common fever of the Eastern States. It is questionable, indeed, whe- 
ther this section of the country is the seat of any other fever, unless it be an 
occasional sporadic case, or epidemic, of an obscure and doubtful character. It 
prevails, also, more or less extensively, in the Middle and Western States. I 
have seen it in Kentucky, where it is sometimes called the red tongue fever. 
It is, probably, less common in those portions of the United States, which are 
visited by the various forms of intermittent and remittent fever than in those 
which are exempt from these diseases; although more extensive and accurate 
observations than have yet been made are necessary to settle this point. Now 
that the means for correct and positive diagnosis of the several distinct fevers of 
our country are becoming more and more generally diffused, there is reason to 
hope that this, as well as some other circumstances, in the natural history of 
typhoid fever, will soon be satisfactorily established. 

"It would seem that the typhoid is the most common and generally diffused 
fever of the temperate latitudes of the continent of Europe. Certainly it is so 
of France, where it has been most extensively and thoroughly studied. It seems 
to be also the common fever of Germany. Louis saw it at Gibraltar in 1828. 
It occurs with considerable frequency in the British Islands, although it is not 
their most common form of fever." 

We must leave future observations to show whether typhoid fever prevails 
more extensively than we are at present aware of, but so far as positive infor- 
mation at present reaches, it seems to us that malarious fevers, or those of a 
periodical type, must be considered as having the widest range. In our own 
country they are found along the whole Atlantic coast south of New York, 
throughout the whole southern and wesiern states, and as far north as the shores 
of the great lakes. In Europe they prevail along the shores of the Mediterra- 
nean; in Spain, Italy, the south of France, Greece, Hungary, and as far north as 
the shores of the Baltic, and in England, to say nothing of their prevalence in 
other quarters of the globe, in the VVest Indies, in Africa and the East. Still 
it is true that it may hereafter be shown that typhoid fever is more universally 
prevalent. All we mean to say is, that at present we are scarcely justifiable in 
assuming this to be true or even probable, for to our minds the probabilities 
rather incline to the opposite side. Of the connection of the disease with cir- 
cumscribed localities, several very remarkable instances are given, which oc- 
curred in New England. 

In the chapter on diagnosis, after giving a general portraiture of the disease, 
and noticing various affections with which it may be confounded, he goes on to 
consider how far the lesion of the elliptical plates is strictly characteristic, and 
consequently how far its presence or absence may be regarded as final and deci- 
sive in reference to the diagnosis of fatal cases. He considers, seriatim, several 
apparent exceptions to this rule, which have been reported, especially the cases 
of Andral, none of which can be shown to be cases of typhoid fever, and most 
of them clearly were not so. Indeed most of the exceptions which have been 

1843.] Bartlett on Typhoid and Typhus Fevers, 167 

advanced clearly depend upon errors of diagnosis, and upon a want of distinction 
between the typhoid state and typhoid fever. 

"It is certainly very important, that this typhoidal state oTthe system, occur- 
ring- in connection with many diseases, should be distinguished from typhoid 
fever. Unless this is done there is an end to all positive and philosophical diag- 
nosis. Since writing this history, I have seen a patient presenting these phe- 
nomena, amongst others:— prostration of strength; sVight subsulfus tendinum,- tym- 
panites; distention of the abdomen; diarrhoea; gurgling on pressure; a dry, red, 
cracked tongue; sordes on the teeth; wandering delirium, and sudamina about 
the neck. Here were many of the most characteristic elements of typhoid fever; 
but the disease was, clearly and unequivocally, puerperal peritonitis. These 
typhoid phenomena, as I have already said, are often present in many diseases; 
in smallpox; in scarlatina; in asthenic pneumonia; in softening of the brain; in 
some diseases of the kidneys; in erysipelas; in dysentery, and so on; but under 
these circumstanceSv where their connection with these several affections can be 
discovered, they ought not to be confounded with typhoid fever. It was from 
disregarding this obvious principle, that Andral was led to the conclusion which 
I have been examining." 

Still some obscure and apparently exceptional cases are from time to time 
though very rarely met with, and our author concludes by observing — 

" In the consideration of this question, as of all others, which are still legiti- 
mate subjects of discussion and controversy, I have sedulously endeavoured to 
avoid any thing like a partisan, or one-sided examination. I have not intention- 
ally overlooked, or put aside, or warped to my mere wishes, if 1 have any such 
unfriendly and treacherous guides and counsellors in the search for truth, any of 
the evidence bearing upon the subject. I have adduced all the cases, that 1 
have been able to find, which might seem to constitute exceptions to this general 
relationship, or to throw doubts upon its invariableness; and the conclusion to 
which I ana irresistibly led is this; that the connection between the diagnostic 
symptomatology of typhoid fever, and the entero-mesenteric lesions, is, 1 will 
not say absolute and invariable, but as nearly so as the connection between the 
diagnostic symptoms, and the characteristic lesions of any given disease, what- 
ever, in the nosology, in which this connection is not established by positive, 
physical signs." 

In the chapter upon the theory of the disease, after observing that our know- 
ledge of the causes of any given fever, their mode of action, the point upon 
which they make their first impression, the character of that impression, &c., 
are wholly or in great measure unknown to us, and consequently that the mate- 
rials for a complete and philosophical theory of fever are wanting, he goes on 
to remark that there is no reason why we may not attempt to commence the 
foundation of a theory of fever, which cannot, however, be carried beyond the 
interpretation of the connection and relationship which observation has shown 
to exist between certain phenomena or groups of phenomena. 

"It ought to be unnecessary to say, that even this can be done only by con- 
fining ourselves to a single well defined, individual form of fever. Under the 
simplest conditions, and where alone it is, in the nature of things, at all pos- 
sible, we shall find this interpretation, or theory, sufficiently obscure and diffi- 
cult. When attempted, as has generally been the case, under other conditions, 
it has proved utterly futile; when applied, as these interpretations and theories 
have generally been applied, to unascertained and imaginary states of the sys- 
tem, they have always degenerated, necessarily, into the idlest of all conceivable 
speculations. There is no such disease as that which has always been express- 
ed, and which is still expressed by the iexm fever. How then can there be any 
theory of fever"? There are many separate diseases, to which this generic name 
is properly enough applied, on account of certain general analogies, which exist 
between them. But the disordered actions and processes, which constitute one 
of these diseases, may differ essentially; and, as far as we can ascertain, in most 
cases they do so differ, from those which constitute another of these diseases. 
The theory of one fever, then, must be wholly, or to a great extent, inapplicable 

168 Bibliographical Notices. [Jan. 

to another. The elements which enter into the composition of one problem are 
not to be found in the other, or they are present in different proportions. The 
word fever ^ when u^ed, as it commonly is, to desicrnate a disease, has no intelli- 
gible signification. It is wholly a creature of the fancy; the offspring of a false 
generalization and of a spurious philosophy. What, then, can its theory be, but 
the shadow of a shade?" 

The above remarks strike us as exceedingly just, and were the views which 
they illustrate more generally appreciated, we should find much less confusion 
on this subject than is usually to be met with in medical writings. We should 
no longer hear of one fever passing into another of distinct nature, any more than 
we hear of a case of smallpox passing into scarlet fever, or the like. In refer- 
ence to the disease before us, our author attempts nothing more than to show 
that it does not depend upon the lesion of Peyer's glands, and consequently that 
it cannot be regarded as a follicular enteritis, but must be viewed as dependent 
upon some ulterior morbid condition, of which the lesion above mentioned is one 
of the consequences. The arguments in favour of this view are very clearly 
and forcibly stated, especial stress being laid in this connection upon the ana- 
logy between the lesion of Peyer's glands and the disseminated inflammation 
which characterises the eruptive fevers, syphilis, &c. As regards the ulterior 
morbid condition above alluded to, which constitutes the essence of the disease, 
different opinions are held. By some it is supposed to consist of an unascer- 
tained lesion of innervation, and by others, of an almost equally unknown alter- 
ation of the blood. Both these views are clearly hypothetical, though we agree 
with Dr. B. in thinking that the latter is the most probable of the two. 

Under the head of treatment, he lays before the reader the plans of practice 
adopted by the most prominent living authorities, as well as that of Dr. Nathan 
Smith, of New England. The essay of this gentleman on the disease before 
us, is altogether a very remarkable one, when we consider the period and circum- 
stances under which it was written. His conclusions upon many points are 
strikingly in accordance with those arrived at by more recent writers. After 
describing the different plans of practice above alluded to, our author observes, 
and very justly, that amidst the claims of conflicting opinions, we are not now 
justified in the use of any ultra or exclusive system of treatment, like that of 
Bouillaud or De Larroque, but that our management of the disease should be 
eclectic and rational. The prominent features of this rational method consist of 
moderate depletion and other antiphlogistic measures at the outset, followed by 
the use of diluent drinks, mild diaphoretics and laxatives, cool enemata, cool 
sponging when the skin is hot, &c. during the course of the disease, together 
with the adoption of such measures as experience has shown to be most useful 
in combating particular symptoms. If we add to these the old fashioned pre- 
scription of minute portions of calomel, ipecac, and opium daring the middle 
and latter periods when the fever still exists, with dry tongue, and other evi- 
dences of deficient secretion, and from the use of which we have often seen the 
most decided benefit under these circumstances, we have a fair outline of the plan 
of practice usually adopted in the hospitals of this city. The exclusive and 
sanguinary system of Bouillaud, the absurdity of which is only equalled by the 
offensiveness of its author, is dismissed with the brief condemnation which it 
deserves. The exclusive treatment of De Larroque, consisting of an emetic, 
followed by the almost indiscriminate use of cathartics up to the time of conva- 
lescence, seems to gain but few advocates out of Paris. 

The second part of the work before us is devoted to typhus fever. This dis- 
ease would appear to be the common fever of Ireland, and also to prevail exten- 
sively in England. In our own country it can hardly be said to exist. Whether 
the spotted fever which prevailed in New England, as well as farther south, in 
the early part of the present century, was really typhus, it is diflScult to deter- 
mine. Under ordinary circumstances, however, it is quite certain that this dis- 
ease presents itself to our notice chiefly in the persons of emigrants, mostly from 
Ireland, or in individuals likely to have had intercourse with such emigrants. 
Even the epidemic of 1836 in this city, described by Dr. Gerhard, was very 

1843.] Bartlett on Typhoid and Typhus Fevers. 169 

limited in extent, and in a great measure confined to the lowest class, the great 
majority of the patients admitted into the alms-house hospital and seen by him, 
having been brought from a very circumscribed district, the St. Giles of Philadel- 
phia, inhabited by the most degraded portion of the population. Still, its study 
should be one of great interest to medical men generally, for if it really is, as now 
seems most probable, a totally distinct disease from typhoid fever, it becomes 
highly important that the question should be generally understood and settled 
upon the most positive grounds. To. lay before the reader the evidence upon this 
point, is one of the leading objects of the vi^ork before us, and one too which has 
been ably accomplished. Under this head we shall have an opportunity of no- 
ticing the most prominent features of the disease, and as in the case of typhoid 
fever, we shall not follow our author in his detailed description of the symptoms 
and post mortem appearances. In the chapter upon the causes of the disease, we 
are presented with a number of facts going to show the influence of age, sex, 
locality, &c. upon its prevalence. Its geographical boundaries, as a common 
and more or less constant disease, are, as Dr. B. observes, much less extensive 
than those of typhoid fever. In this sense, as before observed, it can hardly be 
said to exist in the United States; and on the continent of Europe, it would seem 
that it prevails, not uniformly as in Great Britain, but only as an occasional 
epidemic. In France, for a number of years, it has been almost unknown. 

The contagious nature of this affection has generally been held by the best 
writers, and recent observations entirely confirm the correctness of this opinion. 
Many interesting facts bearing upon this question, derived principally from 
modern British authorities, are brought forward by our author, who arrives at 
the following conclusion: 

"From a pretty careful, and certainly an unprejudiced, examination of this 
subject, in the observations and opinions of British writers, I think we may look 
upon it as well settled, that the morbid actions constituting typhus fever are 
capable of generating in the body a poison, which, when concentrated, and aided 
in its operation by favouring circumstances, will produce the same disease in per- 
sons exposed to its influence. We may consider it, also, as not less certain, 
that the same poison may be generated by other agencies; amongst the most 
active of which seem to be the crowding together in close, unventilated apart- 
ments, amidst accumulated personal filth, of the wretched and suffering poor." 

It will be observed that our author is no advocate for the exclusively conta- 
gious origin of the disease, but on the contrary, that he fully admits that it may 
originate from other sources. Epidemic influence, impoverished diet, and other 
causes, are undoubtedly often intimately connected with the prevalence of the 

The influence of age upon the mortality of the disease is very striking, it 
being much milder in the young, than in those more advanced in life. 

We come now to the diagnosis of the affection, and especially to the distinc- 
tion between it and typhoid fever. The question of the identity or non-identity 
of these two affections is nothing new. Similar controversies to that now 
occupying the attention of medical men are to be found among the older writers, 
by some of whom the distinction between certain forms of fever, described under 
different names, but identical in the main with what we now know as typhoid 
and typhus, was more or less fully recognised. Thus Huxham in an extract 
which our author has placed at the head of the chapter upon this subject, speaks 
of the great difference between the putrid malignant and the slow nervous fever, 
and the errors in practice which arose from a want of this distinction. After, 
however, the general history, and especially the morbid anatomy of typhoid 
fever, were so clearly made out and established by Louis, it became a matter of 
great interest to determine whether that form of typhus, epidemics of which had 
been described under the names of petechial, of jail fever, &c., presented the 
sanie morbid appearances, for the determination of this point was clearly one 
which must have great influence in settling the question of identity. That a 
large proportion of the cases of typhus in England and Ireland, do not present 
the intestinal lesions of typhoid fever, is now admitted by all, but it is still a 

170 Bibliographical Notices. [Jan. 

question whether these lesions characterize a distinct disease, or are only to be 
regarded as a complication belonging to certain cases of typhus. Were this 
idea correct, it seems to us that we should find in these cases, the symptoms of 
true typhus with the addition of those which belong to the intestinal affection. 
This, however, is not true. On the contrary we find in the cases characterized 
by intestinal lesion, not merely the superaddition of abdominal symptoms, but 
other points of difference of the greatest importance. Thus in typhoid fever the 
eruption is very different from what is met with in typhus, that of the former 
consisting of a few rose-coloured elevated spots, mostly confined to the chest 
and abdomen, whilst in typhus it is abundant and general, of a dusky colour, not 
elevated, and but partially or not at all disappearing under pressure. The odour 
of the body is said to be different in the two diseases, and the heat in typhus is 
more pungent. The difference in the expression of the countenance is so marked 
that it is of itself sufficient in many cases to enable the experienced physician to. 
distinguish between them. The average duration of typhus, also, is consider- 
ably less than of typhoid fever. The former is more common in persons of ad- 
vanced life than the latter, and finally the influence of remedies is very different 
in the two diseases. Having pointed out the distinguishing features, our 
author observes: 

" If this alleged and well-defined difference between typhoid and typhus fevers 
really exists; if these two diseases are radically and fundamentally diverse, and 
unlike each other; and if the diagnosis between them can be generally estab- 
lished, it becomes a matter, not only of scientific interest, but of great practical 
moment, for us to inquire how far this distinction is recognised, either in form 
or in fact, by the leading and classical British writers, who have long been and 
who still continue to be, to a very great extent, at any rate, our guides and au- 
thority on the subject of one at least of these diseases. What do they mean by 
the terms typhus fever, cominon continued fever, slow nervous fever, and so on^ 
Do they describe a single disease, essentially indentical in its nature, and differ- 
ing only in its form, under these several appellations'? If so, what is this dis- 
ease? Is it typhus fever, or is it typhoid fever? On the other hand, do they 
describe distinct and separate diseases, under these several appellations'? If so, 
what are these diseases'? Are they typhoid and typhus fevers, or are they some- 
thing else? Certainly, I need not say how necessary it is to all sound science 
and to all successful or even safe practice, that we should understand each other 
upon this primary and fundamental point of diagnosis. Certainly, I need not 
say what contradictions and what inextricable confusion must inevitably grow 
out of the want of this understanding. In order to determine, as far as may be, 
the questions above indicated, I will briefly examine the opinions and observa- 
tions of some of those British authors, whose works are most generally in the 
hands of our own practitioners, and whose writings have most extensively in- 
fluenced their doctrines and their practice. Amongst these, I may mention, par- 
ticularly, John Armstrong, Southwood Smith, and Alexander Tweedie." 

After an examination of the statements of the writers just mentioned, as well 
as a careful analysis of the investigations which have been made in reference to 
the same question during the last few years, our author arrives at the following 
conclusion, with which in the main, we entirely coincide. 

"Such is the history, as full and fair as I have been able to make it, of the 
recent investigations in regard to the relations between typhoid and typhus 
fevers. Excepting those of M. Landouzy, it seems to me, that they all go to 
show, that the two diseases are radically and essentially dissimilar. 1 have no 
wish, whatever, to make out a case in this matter. I would avoid, scrupulously, 
anything like special pleading. The truth, as Louis's motto from Rousseau 
says, is in the things, in the facts and their relations, not in my mind, which 
attempts to judge and to interpret them. I am anxious, only, that this truth, be 
it what it may, should be ascertained. That this has been done absolutely and 
definitively, I do not pretend. That typhoid and typhus fevers are, clearly and 
unequivocally, fundamentally distinct diseases, may not have been positively 
demonstrated. I admit, that the paper of M. Landouzy throws some doubt upon 

1843.] B2.n\Q{{ on Typhoid and Typhus Fever. 171 

the question. But, as has been remarked before, whether the two diseases be 
or be not specifically and nosologically unlike each other, it is equally important, 
that the wide differences which confessedly do exist between them should be 
pointed out, and their real relations established. This I have endeavoured, so 
far as the present state of our knowledge conld enable me, faithfully and truly 
to do. 

" In regard to the identity of the former camp and jail fevers of the European 
continent, either with typhoid fever, or with typhus, it is not possible to come to 
a positive conclusion. Louis thinks, that they were typhoid; others think, that 
they were typhus. It is probable enough, that both forms of fever may have 
prevailed. At any rate, the descriptions given of them are generally so imper- 
fect, that it is wholly impossible now to decide this question with any degree 
of certainty. It is quite as well, perhaps, not to attempt its solution at all." 

As regards the former camp and jail fevers of the European continent, it does 
seem to us highly probable, that some of them at least were examples of true 
typhus. Such, for instance, we should consider the disease described by Pringle, 
and the petechial fever of Italy, an account of which has been given by Rasori. 

The paper of M. Landonzy, mentioned in the extract given above, appeared 
during the present year, and contains a history of an epidemic which appeared 
in the prison at Rheims, in which most of the symptoms were strikingly simi- 
lar to typhus, whilst the post mortem appearances in part resembled those of 
typhoid fever. The elliptical plates were either thickened and elevated, or 
they were the seats of ulcerations; and the mesenteric glands, corresponding to 
them, were enlarged. The spleen was not increased in size in any of the cases; 
in four it seemed somewhat softened. Such a combination of symptoms and 
post mortem appearances have been noticed, we believe, by no previous writer; 
and they are certainly calculated to make us pause and await the results of 
future observation in reference to the question of the identity of these several 
forms of fever. "If," as M. Landouzy observes, (we take our author's transla- 
tion as quoted by him,) " in all future epidemics of the typhus of camps, of jails, 
of hospitals, &c., we find, as in that of Rheims, complete absence of disease of 
the spleen, and great diflferences between the symptoms and those of typhoid 
fever, we must confine ourselves to the conclusion, that typhus and typhoid 
fever are analogous, and not identical diseases. If, on the contrary, we find*, 
that in one epidemic, diarrhoea is absent, in another the petechial eruption, in 
another the rose spots, and so on, we must conclude, that these diflferences de- 
pend only upon variations in the action of the epidemic cause, and that the dis- 
ease is, in its nature and essence, identical with typhoid fever." 

We have now completed a very cursory notice of our author's account of these 
two fevers. He has succeeded in presenting to the reader a very full summary 
of what is known in reference to them, couched in clear and concise language, 
and unincumbered by loose disquisitions or fanciful speculations. He has shown 
great skill in the collation of his materials, and a truly philosophical spirit in the 
cautious and logical inductions which he has made. His work is one which 
amply supplies, as he intended it should, an undoubted deficiency in medical 
literature, at least in this country, and should be read by every physician who 
wishes to have precise views on the subject of which it treats. The volume 
closes with a short account of the diagnosis of bilious remittent, and yellow 
fevers, which we shall not examine in detail, especially as many of the views 
maintained in it, have been already sustained in this Journal by the writer of 
these remarks. T. S. 

172 Bibliographical Notices » [Jan. 

Art. XIV. — Elements of Physiology. By J. Muller, M. D., Professor of Ana- 
tomy and Physiology in the University of Berlin, etc. Translated from the 
German, by Wm. Baly, M. D., etc. Arranged from the Second London 
Edition, by .Tohn Bell, M. D., etc. 8vo. pp. 886. Philadelphia, Lea & 
Blanchard, 1843. 

In a review of the greater portion of Professor Miiller's Elements of Phy- 
siology, published in this Journal upwards of two years since, we took occasion 
to express our high estimate of the work, as affording a very full, able, and 
correct digest of the present state of physiology; in which the well established 
facts connected with the science are carefully distinguished from whatever is 
doubtful or purely hypothetical, and presented with that degree of distinctness 
and prominence, which is well calculated to convey to the reader clear and ac- 
curate views in relation to all that is known of the vital phenomena of the human 

The work before us is, strictly speaking, an abridgement of the larger work of 
Professor Muller from the English translation of Dr. Baly, in the execution of 
which, the editor, Dr. Bell, has exhibited no little skill and judgment. 

We confess, that we have invariably entertained decided objections to all 
abridgements, but especially to those of scientific works, as being, in most cases, 
calculated to present imperfect, unfair, and even erroneous views of the labours 
of authors, and in this manner to mislead and bewilder the reader — we must 
nevertheless admit, after a tolerably minute and careful examination of Dr. Bell's 
abridged edition of Miiller's Elements, we find that to it our objections to 
abridgements in general will scarcely apply — in truth, so well has the able editor 
accomplished his task, that, in many respects, but especially for the use of 
students, the abridgement is decidedly to be preferred to the original. 

The omissions in the abridged edition, are of a character in no degree calcu- 
lated to render it a less complete system of physiology than the larger work — it 
still "exceeding in copiousness and comprehensive details, any other work on 
the same subject," within the reach of the great body of the profession in this 

The portions of the original work omitted in the abridgement, consist, to use 
the language of Dr. Bell, the accuracy of which we have tested by examina- 
tion, " for the m.ost part, of mere disquisitions, many details of experiments, mat- 
ters of physics and natural philosophy, including mechanics under the head of 
locomotion, acoustics and the theories of music, under voice and hearing, and of 
optics under vision — much of the minutiae of comparative anatomy, and meta- 
physics or metaphysico-physiology. But, while excluding details on collateral 
topics, the editor has been particularly careful to preserve physiology proper, 
which, resting on the basis of histogeny and general anatomy, derives import- 
ant aid from organic chemistry and microscopical observations, and, in its turn, 
serves to illustrate hygiene, pathology and therapeutics." 

"In some parts of the ' Elements,' comparatively little abbreviation has been 
attempted; — as in the prolegomena of general physiology, which is a carefully 
condensed summary of the subjects embraced under the general head, and does 
not admit, without obscurity, of any material curtailment. So likewise, in the 
case of the functions of organic life, those of assimilation, nutrition and decom- 
position, much of the copiousness of facts and illustrations which constitutes 
so distinguishing a merit in the larger work, has been retained in the abridge- 

Some slight, but upon the whole, judicious changes in the arrangement of the 
subjects, have been made in the present edition; and a few notes at the foot, and 
some paragraphs in the body of the page, have been added by the Editor, em- 
bracitig matter of a useful, and, in one or two instances, highly important cha- 

1843.] Trans, of College of Physicians of Philadelphia. 173 

" With the exceptions just stated," Dr. Bell remarks, and we freely admit the 
correctness of his statement — " not only his manner of treating the various suh- 
jects, but the language of the author, has been preserved throughout, and hence, 
when it shall be discovered, as it readily may, by a comparison of the contents 
and index with those of the London edition, that there is scarcely a fact or pro- 
position in human physiology, and none of either applied to hygiene, pathology 
or therapeutics, in the original work, as translated by Dr. Baly, that is not met 
with in the present volume, it will not be considered too much to say, that this 
latter contains emphatically Miiller's 'Elements of Physiology,' with nearly the 
characteristics which give it value in the eyes of the student. So earnest has 
been the desire of the editor to complete in a suitable manner his arrangement of 
the work, that he has retained nearly all the bibliography, which manifests the 
extensive reading and research, as well as love of accuracy of the autfior. Not 
only did this measure seem to be due to Miiller himself, but also to his readers 
in this country, the latter of whom will have it in their power, when quoting 
Miiller, to repeat his references to ail the authors on every leading question in 
physiology, and to carry out, if they desire it, an independent course of inquiry 
for themselves." 

We should have been still more pleased with the present edition of the Ele- 
ments of Miiller, had the additions to and annotations upon the original text, by 
the translator. Dr. Baly, been, througrhout, as distinctly marked as in the liOndon 
edition. It is important, in many points of view, that the reader should always be 
aware of the facts and opinions which are to be referred to the authority of the 
author himself, and those which have been added by successive editors; — unless 
the means are afforded him for making this distinction, injustice may be un- 
intentionally done to all the parties concerned — author, editor and reader. 

Taken as a whole, we may remark in conclusion, that the present edition of Dr. 
Miiller's " Elements of Physiology," as condensed and arranged by Dr. Bell, 
can, with great propriety, be recommended to the notice of all who desire to 
become acquainted with the vital phenomena and laws of the living organism, 
so far as they have been revealed to us by cautious observations and experiments. 
In no work can these be studied with greater profit than in that of the Berlin 
Professor — all the important materials of which, as well as all "its vitality and 
mind," have been carefully retained in the abridgement before us. D. F. C. 

Art. XV. — Quarterly Summary of the Transactions of the College of Physicians 
of Philadelphia. August, September, and October, 1842. 

The principal papers read before the College the past quarter were, the history 
of a case in which an aneurismal sac was formed within the cranium, by Pro- 
fessor Dudley, of Lexington; a case of biliary calculi, by Dr. W\ S. Zantzinger; 
on the construction of Insane Hospitals, by Dr. B. H. Coates; and the result of 
personal observations and investigations during the last five years, on the subject 
of Mesmerism, by Dr. .1. K. Mitchell. 

Dr. Dudley successfully treated his case of aneurism within the cranium by 
tying the common carotid artery. The following are the details of this case: — 

" J. C. Burgess came to Lexington in the winter of 1841, and gave the follow- 
ing history of his case: — As early as 1836, he had become subject, at irregular 
periods, to pain over the right eye, which gradually increased, both in the fre- 
quency of its recurrence, and in the attendant sutfering; and before the expiration 
of thetsecond year, the eye was considerably protruded from the socket. In 1839, 
the right temple, as well as the eye of that side, was morbidly prominent, and 
about this time the pain became so excruciating, as to occasion delirium, one at- 
tack of which was protracted to fifteen days. Occasional severe pain was at this 
period of the case experienced also in the left side of the face and temple. 

"During the winter of 1838-9, for a number of weeks, his suffering was inces- 
sant, but was finally much lessened after a copious spontaneous discharge, from 
No. IX.— January, 1843. 12 

174 Bibliographical Notices. [Jan. 

the nostrils, of a yellow fluid. Increased suffering, ever after, succeeded to any 
interruption of this nasal discharge; and for some months previous, as vi^ell as 
subsequent to his arrival in Lexington, he was often alarmed at what he feared 
might result from nasal hemorrhage, and consequent death. He represented his 
right eye as entirely useless in regard to all distant objects, and in his right ear 
he was perfectly deaf. Various remedies had been advised by different physi- 
cians, and much speculation indulged upon the nature and the cure of the mala- 
dy. To the examiner, the first object that attracted attention, was the enlarged 
and protruded eye, which was something like half an inch in advance of the 
other. The inferior and external portion of the os frontis, including the orbitar 
and the external half of the superciliary ridge, were deeply involved in the 
malady; and in conjunction with corresponding portions of the parietal, tempo- 
ral, and sphenoid bones, separated from the bodies of these bones, were involved 
in one common enlargement of that side of the head and temple. The bones 
of the head and face were separated at the external angle of the eye, suffi- 
ciently to admit the end of the little finger into the site of the transverse suture. 
The whole of the enlarged mass communicated the thrill to the touch which is 
characteristic of aneurism, while a lateral view of the eye-ball presented an alter- 
nate protrusion and recession of this organ, corresponding to the action of the 
heart and arteries. 

"The treatment preparatory to a successful operation, which consisted in the 
use of plainly dressed, easily digested food, in moderate quantities, with the use 
of such evaeuants as were necessary to place the alimentary canal and the organs 
tributary to digestion, in a favourable state, having been instituted, much of the 
suffering of the patient was allayed, and in the month of January he was brought 
before the medical class, when a ligature was applied to the common carotid ar- 
tery. The effect of the ligature upon the artery was immediately sensible in 
the eye, and all that side of the head and face. The eye gave no more evidence 
of pulsation, the circulation in the integuments immediately became very lan- 
guid, the tenseness of the whole of the parts involved in the enlargement was 
greatly lessened; while the patient expressed himself as being suddenly relieved 
of all noise and motion in the head. For two days no unpleasant symptom su- 
pervened; then a distressing cough came on, attended by the sensation of a foreign 
body in the windpipe, opposite to the wound, which deprived the patient of 
much rest for several days. On two or three occasions, during the progress of 
his recovery, he was attacked with severe pain in the head, attended with some 
fever; thus exciting an apprehension at first, that the aneurism in the brain might 
be progressive, by reason of the free communication between the different arte- 
ries of that organ. The use of small nauseating and purgative doses of calomel 
and ipecac, by which means fever was checked, and bile copiously discharged, 
exemplified the presence of that law, so well understood by ancient, as well as 
modern authors, which connects the cerebral and hepatic functions in disease. 

"The rapid subsidence of the tumid state of all the parts involved in the dis- 
ease by the end of the first week from the operation, rendered manifest the 
changes they had undergone. Isolated spicules of bone could then be distinctly 
traced, beginning about the centre of the superciliary ridge, and invading por- 
tions of the parietal and temporal bones; while the little finger could be passed 
into a vacuity, at the outer angle of the eye, corresponding to the transverse 
suture. By the end of the twentieth day from the operation, the line of separa- 
tion between the bones had become obscure; the spicule were indistinct, while 
the whole enlargement was rapidly on the decline. The eye, now restored almost 
to its natural position in the socket, had recovered its usefulness for distant ob- 
jects of vision; and the ear, which had been deaf, was now as aciitely sensible 
to sound as the other. Before the end of the month, the patient being free of 
all disease, left Lexington for St. Louis, the place of his residence. 

" He continued well for some time after his arrival at home; but upon throw- 
ing off all restraint in diet, drink, and exercise, his health suffered greatly, and 
made it necessary for him to apply to his family physician, Dr. Hall, through 
whose skill he was relieved. He is now, six months since the operation, in the 

1843.] Trans, of College of Physicians of Philadelphia. 175 

enjoyment of good health, and engaged in the labours of a blacksmith. My asso- 
ciate, Prof. Bush, saw a case in one of the Parisian hospitals, somewhat like the 
preceding, and for which nothing was proposed to be done by the surgeon in at- 
tendance. In the cases referred to in a late volume of the London Medico-Chi- 
rurgical Transactions, the aneurism appears to have been located on the branches 
of the external carotid, and to have been excluded from the cavity of the cra- 
nium; whereas, in the case now detailed, the only doubt which remains, is as 
to the extent of the aneurismal sac within the cranium, with the consequent loss 
of cerebrum by absorption. 

"The great loss of cranium by absorption, the general enlargement of the 
forehead and temple, the preternatural development and projected state of the 
right eye, and the loss of hearing in the right ear, added to the long-continued 
suffering of the patient, admits of the inference, that the right hemisphere of the 
cerebrum may have been as extensively absorbed, in consequence of the pressure 
of the aneurismal sac, as in other cases it is known to be, from the presence of 
serum in the ventricles." 

The following deductions are drawn by Dr. Mitchell from the various facts 
detailed by him in his communication: 

"1. The investigations into the claims of mesmerism have been hitherto im- 
perfect, because they have been conducted either by interested partisans, or pre- 
judiced opponents. 

"2. All previous examinations of this difficult subject have been directed 
rather to its undue pretensions, than to its less obtrusive foundations. 

*'3. The researches of the committees detailed by learned societies, have been 
contradictory and unfruitful, chiefly, because the trained subjects of the mes- 
merizers were examined, instead of those among their own friends and acquaint- 
ances, on whom they could rely for the unsophisticated representation of the 
natural phenomena of mesnjerism. They invited deception, and either implicitly 
confided in it, or, having detected the attempt to mislead, condemned the whole 
system as one of fraud and imposture. Hence, they were always in those ex- 
tremes which border on truth, but are never within its confines. Astronomy is not 
the less true, because the ignorant believe that the stars are holes through which 
the light of Heaven breaks, or because astrologers pretend to see the fates of 
liumanity registered in the conjunction and disseverance of the planets. 

*'4. Imagination and imitation cannot account for the uniformity of the phe- 
nomena of the mesmeric state, in persons of all ages and conditions, who are 
totally ignorant, not only of the symptoms to be produced, but of the design of 
the mesmerizer. 

"5. Neither will they explain the analogies found to exist between natural 
and artificial somnambulism. 

"6. Nor can we, by any rational view of their cases, ascribe to any thing but 
a physical influence, the effect of passes on the diseased condition of certain pa- 
tients, some of whom did not observe the manipulation, and none of whom un- 
derstood its import. 

"7. Admitting that the mesmeric sleep may be and is produced solely by 
mental means, the method as well as the phenomena of restoration, both in na- 
tural and artificial somnambulism, forbid us to believe that the patients are 
usually conscious either of the act or the intention. Many of them showed 
plainly their ignorance by their conversation at the time, and others were totally 
incapacitated for observation. 

*'8. If we admit the awakening without the aid of the patient's mental co- 
operation, we can find no reasonable difficulty in believing that the mesmeric 
sleep is producible also without that co-operation. 

"9. The phenomena of artificial somnambulism are, — 1. An exaltation of 
the circulation, without a corresponding increase cf the respiration. 2. An ob- 
tunded sensibility to causes of pain, and sometimes, though rarely, its total ob- 
literation. 3. The more or less complete obliviousness of the thoughts and 
events of the mesmeric state, while awake, although the memory of the events 
of the natural state is strong in the artificial state. 4. The retention of locomo- 

176 Bibliographical Notices, [Jan. 

lion and the facility of beinor led into suggested dreams, are also curious effects 
of the mesmeric action. Nothing is too high for the daring, or too absurd for 
the belief of the dreamer. But all the mesmerized patients are not susceptible 
of this influence. A few subjects resist, even when asleep, all attempts to 
mislead them, although they present most of the other peculiarities of somnam- 

"10. To this property of artificial dreaming may be referred the alleged mira- 
cles of clairvoyance, intuition, and prevision. The subject dreams that he sees, 
and the questioner is deceived, by his confidence, his plausibility, and his ordi- 
nary character. He knows him to be honest, and he does not perceive that he 
is himself led astray by his uncorrected imagination. There is all the eflfect 
of a fraud, without intention to mislead, and without blame. 

" 11. The mesmeric effect is usually producible within ten minutes, and at the 
first sittings but some persons have yielded only after long and repeated trials. 
In general, unless very marked effects are exhibited within half an hour, all sub- 
sequent attempts to mesmerize are fruitless. 

" 12. The mesmeric sleep may be dissolved by time alone, the natural dura- 
tion of the paroxysm lasting from thirty minutes to nearly five hours. The fear of 
not escaping from the spell, in the event of the death, or absence, or loss of 
power of the magnetizer, is therefore not well founded. 

"13. The artificial solution of the mesmeric sleep requires sometimes only a 
single wave of the hand, sometimes many. The mean time is about two mi- 

" 14. Independently of the voluntary aid of the mesmerized subject, the time 
taken to dissolve the sleep is very sensibly aflfected by the distance from him. 
Thus, in contact, a case consumed 4' 4"; at two yards, T 30'^; at four yards, 
16' 45". 

" 15. Sex does not appear to exejcise any very marked influence on the mes- 
meric susceptibility. 

" 16. Age is a more modifying cause than sex. Though no age is exempted, 
the very young and old seem least susceptible; and the period of life between 
12 and 20 is that most favourable to the mesmeric influence. 

"17. Of" the temperaments, the nervo-sanguineous seems most liable to the 
mesmeric action. 

" 18. Although without an exception, so far as I can discover, mesmerists 
agree in believing that a sound slate of health is unfavourable to the success of 
their operations, I have found it most conducive to well marked mesmeric 
results. Of twenty-six somnambulists, nineteen were in good, and seven in bad 

" 19. The mesmerizing power seems to be very generally possessed, but the 
susceptibility to soporose mesmeric impression is confined to a few individuals, 
being about one in seven or eight of those subjected to the trial. 

"20. The rapport, relation, or communication, supposed to have an absolute 
existence, dependent on the mesmeric fluid, seems to be entirely voluntary on the 
part of the patient, and to rest on his knowledge of its supposed necessity. It 
is, therefore, a delusion, but one of the greatest convenience to the public exhi- 
bitors of mesmeric wonders. 

"21. The delusion as to the '-rapport'' is one of the many hallucinations of the 
mesmeric state, for which the subject of it is no more answerable than for any 
of the wild and monstrous dreams to which the disordered fancy may be led, in 
that unnatural condition both of mind and body. This truth is clearly proved 
by analogical cases of insanity, where similar delusions continue for years. 

" 22. The mesmeric state curiously modifies the condition of the senses. Sight, 
hearing, and touch, are usually improved; taste, smell, and sense of pain, as 
commonly impaired. 

"23. As the sense of touch and of pain are so diversely affected by mesmer- 
ism, we are led to regard them as independent senses; probably, therefore, sup- 
plied by separate nervous fibres. Such an inference ought to have been made 
before, for many organs have the sense of pain, but not the sense of touch. The 

1843.] Trans, of College of Physicians of Philadelphia. 177 

presence of a poison will give pain to the stomach or intestines, which do not 
perceive the motions of the worms that infest them. If tiiis view be correct, tiie 
sense of pain is a sixth sense. 

"24. Many of the feats of the clairvoyants are the result of the sharpened 
hearing-, which enables them to detect objects by the sounds they make. They 
really believe they see them, and so does the exhibitor, although he aids them 
by handling audibly the various objects. Thus he opens and shuts a pencil, a 
penknife, or a spectacle-case, and rubs a stick, or a sheet of pasteboard. He 
always makes as much noise as possible with every thing, and he generally asks 
the producer of a marked card to explain the words or device to him. 

*' 25. As we cannot believe in mesmeric ' rapport,' so we are not able to cre- 
dit the existence of any peculiar sympathy between the operator and subject. 
Untrained or ignorant patients never show sympathetic phenomena. I have 
been pinched, and hurt otherwise, a great many times, without observing any 
suffering on the part of my subjects, until they were taught to believe that such 
a relation existed; and then they very honestly felt hurt, as people do in dreams 
— a kind of imaginary suffering. 

"26. The phrenological phenomena of mesmerism, when rigidly examined, 
are found to consist, as do most of the mesmeric wonders, of ' such stuff as 
dreams are made of.' The excitement of the brain is general^ the diredtion of that 
excitement is given by the mesmerized person'' s knowledge of phrenology i but the 
patient is not in any case aware of his mental co-operation. This singular delu- 
sion or mis-apprehension, runs through nearly the entire subject of mesmerism; 
most of the phenomena of which are a strange mixture of physical impulse and 
mental hallucination. Phrenologists alone feel the phreno-mesmerie excitement. 
Persons partially acquainted with phrenology, experience it only as to the 
organs known to them; while those who are totally ignorant of the subject, 
present no local manifestations, until they are taught, either awake or asleep, 
what they should know, and what they should do. The displacement of old 
organs, in one city, their retention of location in another, and the adherence of 
the patients to the peculiar and dissimilar systems of phrenology, which they 
have, respectively, been taught, show clearly, that the direction of the cerebral 
excitement is personal and arbitrary; while the new maps of the cranium, so 
widely different from each other, leave us no longer in the least doubt as to the 
delusive source of the compound science of phreno-mesmerism* 

" 27. The mesmeric influence is the effect of what the natural philosophers 
call induction. The will of the operator acts solely on himself; his altered 
system re-acts on the subject of the experiment, by an unexplained power, ana- 
logous to the equally inexplicable induction of the mechanicians, and the pre- 
sence of the chemists. 

"28. Mesmerism may be sometimes usefully employed to allay nervous irri- 
tation, procure sleep, and obtund nervous sensibility, during surgical operations; 
but from the fewness of susceptible persons, it can be used very seldom for such 
purposes. In all other cases it appears to be of little use; and so far as I know, 
has never cured any serious disease. On the other hand, it sometimes, espe- 
cially in unpractised hands, produces frightful disorders both of mind and body, 
and should therefore be resorted to solely for proper and important purposes, and 
then only with due precaution. 

"29. The cases of natural somnambulism, so like those of the mesmeric state, 
the permanent magnetic power of some individuals, the relief afforded to para- 
lysis and stupor, and the restoration from na^ura/ somnambulism by mesmeric 
passes, go far to show that the disturbance of the nervous system, which is pro- 
duced by mesmerism, may and does occur in certain stages of disease, and is not 
unfrequently present in nervous affections where we have not hitherto suspected 
its coincidence. 

" 30. Mesmerism may, for the above reasons, be employed to relieve, tempo- 
rarily, affections of a nervous character, when the usual means fail; but it should 
be used always with caution, and only when the failure of all ordinary measures 
renders its application a matter of necessity. 

178 Bibliographical Notices. [Jan. 

"31. The claims to a peculiar medical intuition, set up by magnetized per- 
sons, or their exhibitors, is destitute of foundation. The pathology is usually 
absurd, the prescriptions are inefficient, dangerous, or ridiculous, and after sixty- 
eight years, mesmerism has not detected a new theory of disease, or suggested 
one useful remedy. 

" In conclusion — I maybe, perhaps justly, charged with giving to the subject 
of mesmerism an undue importance, and bestowing on it, a disproportionate 
share of time and attention. The results, being chiefly negative, add almost 
nothing to our stock of knowledge, and the pretensions now demonstratively over- 
thrown, being discarded already by common sense, and the antecedent labours 
of others, scarcely deserve, in the opinion of the world, a passing notice. But 1 
think I am justified in my laborious investigation, by the interest still felt in the 
subject, over a large part of the civilized world, by the want of digested and 
comprehensive facts, and by the bearing of the phenomena on the practice of 
medicine, and on the physiology of the nervous system. Perhaps, too, it may 
not be unimportant to the guardians of public and private morals, the adminis- 
trators of justice, and the conservators of family and educational discipline, to 
learn, what unsus])ected physical agents are at work on the human frame, at all 
times, and in all places. They may thus be enabled, not only to guard against 
abuses, but to make indulgent and charitable estimates of the character and ex- 
tent of crime and error. 

"Doubtless, the mesmerists will say that I pay too little attention to the 
testimony of others on many of the points in which I differ from them, and 
others may allege that for all that part of the subject which I admit to be true, 1 
give too much weight to my unsustained personal labours and observations. To 
both, I may with truth, and without undue pretension reply, that I did not ex- 
pect to settle any question definitively by these researches. They were made 
carefully and honestly, and the results set down without exaggeration or ex- 
tenuation, for the purpose of making as close an approximation to an obscure 
truth, as the time and opportunity would permit. Others, following in the same 
exact path, may enforce or weaken my conclusions; but sure I am, that it is 
only thus that we shall finally settle these vexed questions, and not by opinions 
founded on unrecorded observations, or vague generalities derived from loosely 
kept records. While I find volumes of conclusions, I discover no tables to 
which I can refer for support or refutation. I see many edifices, but I discover 
no foundations for them^ and naturally infer that as they rest on no solid bases, 
they are without weight, and made of imagination. 

" As to the charge of refusing the testimony of others, I answer, that their 
evidence is so conflicting as to destroy itself. The most substantial proof, that 
of distinguished medical men, is usually on my side, and if I have not availed 
myself of that, how can those complain who give opinion on the other side. 
Few are competent to observe, in a question involving medical knowledge, and 
scientific attainment. He who would truly understand such phenomena, must 
know all that is known of the nervous system, and much that is taught as physi- 
cal science. He must have studied also the human mind in health and disease, 
and have examined the kindred complaints of somnambulism and catalepsy. 
Now, it is not a little remarkable that the authors who have written in favour 
of the higher claims of mesmerism, have not been thus prepared, while the 
more accomplished observers have decided against those claims. Let me illus- 
trate this farther. Phenomena are observed in the heavens — among the stars. — 
Every one sees them — but to whom do we look for the explanation by which 
these phenomena are fashioned into facts. For how many thousand years did 
the constellations glide across the zenith, in nightly brilliancy, observed by 
millions of eyes, before the splendid phenomena assumed to the human under- 
standing the shape of a fact. Until explained by Copernicus, it was a bright 
illusion — the very opposite of that which it seemed. If this illustration does not 
lessen the confidence of ignorant observers in their powers of discrimination, I 
am at a loss for means to teach them humility, which can alone give much value 
to the observations of any one, however otherwise prepared for investigation. 

1843.] Raciborshi on Auscultation, 179 

That sleepers often describe well distant places and events, is true; but does it 
follow that they obtain the knowledore by spiritual inspection? Or are they in- 
debted to other and more intelligible means of discrimination'? It is not less 
true, that there is sometimes the manifestation of strong personal sympathy be- 
tween mesmerizer and subject, but are there not unexamined sources of error in 
the most obvious explanation of this phenomenon? The dispute is less as to the 
appearances, than as to the view to be justly taken of them. The vast and airy 
beings that darkened for ages the skies of the Brocken Mountain, were the 
wonder and terror of the ignorant peasantry, until more competent observers 
proved them to be the shadows of human beings, cast by the rising and setting 
sun in exaggerated volume, on a screen of clouds. That which had been a 
frightful phenomenon, became an agreeable fact. The shadowy things of artifi- 
cial somnambulism have long enough displayed their visionary forms on the sky 
of human wonder. It is time to give them that true import which will take 
them from the mountebank and pretender, and place them in the hands of philo- 
sophy. If I can believe that I have done so much as to bring philosophy to the 
task, free from prejudice and restraint, I shall be satisfied tiiat my labour has 
not been in vain." 

Art. XVI. — An Elementary Treatise on Auscultation and Percussion^ or the 
Application of Acoustics to the Diagnosis of Diseases, with a Synoptical table. 
By A. Raciborski, M. D., &c. Translated with notes, &c., by Minturn 
Post, M. D. New York, Collins, Keese & Co., 1839, pp. 261. 1 plate. 

The excellent manual of Raciborski on auscultation and percussion, of which 
the above is a translation, appeared some years since in Paris. It is divided 
into two parts, the first of which opens with an account of the history of percus- 
sion, the mode of its employment, and the general results to be derived from it. 
Next we have a most accurate and minute description of the mode in which the 
thorax should be percussed, the different characters of the sounds elicited in its 
several sections in the healthy state, followed by an account of the abnormal 
conditions of the contained organs, and the modification of sound thence result- 
ing. The application of percussion to the exploration of the abdomen is next 

A similar plan is adopted in treating of auscultation, except that here a larger 
space, comparatively speaking, is occupied with a disquisition upon the structure 
of the lungs, and upon the anatomy and physiology of the heart's action. Upon 
the first of these subjects, the translator has added in a note the important results 
of Dr. Horner's observations. 

The second part of the work is occupied with a short account of the applica- 
tion of the processes just mentioned, to the diagnosis of particular pectoral and 
abdominal affections. The whole concludes with a synoptical table, in which 
you may see at a glance to what condition of organs any particular sound cor- 
responds, the mechanism of its formation, and the diseases in which it is found. 

The descriptions are lucid and concise, and the style of the present edition 
highly creditable to the translator. In short, it is an excellent manual for the 
student in auscultation and percussion; one of the best indeed which we have 
met with. T. S. 

Art. XVII. — The Evolution of Light from the Living Human Subject. By 
Sir Henry Marsh, Bart., M. D., &c. &c. &c. Dublin, 1842, pp. 59, Svo. 

The subject of this paper is a very curious one, and well deserving of further 
investigation. The author has collected a number of striking instances of lumi- 
nousness throughout the extended range of inorganic and organic matter, and re- 

180 Bibliographical Notices. [Jan. 

lates four remarkable instances in which it was observed emanating from the 
human body. In all these cases disease had made deep ravages in the system. 

Sir Henry conceives that this phenomenon has the closest analogy to the phos- 
phorescence generated in organic bodies at the period of incipient decomposition, 
and that a process analogous to decomposition may take place in the human 
frame whilst yet the living principle remains. Disease implies, he maintains, 
and with justice, that to a certain extent, however slight that may be, the vital 
property is impaired and altered, and that unless combatted by art, and stayed 
in its progress by the restorative power implanted in the living system, it will 
inevitably lead to that condition which gives to the chemical actions the ultimate 
mastery over the vital; and he believes that while the flame of life flickeringly 
burns on, the diseased or injur-ed part may be reduced to that state which in ani- 
mal matter is perfectly analogous to the first and earliest stage of decomposition; 
and other conditions existing, light may be evolved precisely in the same man- 
ner as this phenomenon is produced in the dissecting-room, in burial-grounds, 
and in marine animals during the early stage of decay. It is not improbable, he 
adds, that all cases of this kind may ultimately be referred to one common head 
— to chemical actions in peculiar conditions evolving light through the instru- 
mentality of electrical phenomena. 

Art. XVIII. — Jl System nf Human Anatomy, General and Special, By Erasmus 
Wilson, M. D., Lecturer on Anatomy, London. American edition, edited by 
Paul B. Goddard, A. M., M. D,, Demonstrator of Anatomy in the University of 
Pennsylvania, &C.&C. &c., with one hundred and seventy illustrations by Gil- 
bert. From the second London edition. Philadelphia, Lea and Blanchard, 
1843, pp.576, 8vo. 

In our last Number, p. 442, we noticed this excellent and beautiful work, and 
it is only necessary now, in noticing the American reprint, to say, that in point 
of beauty, it equals the original, besides being enriched with some additions, 
both to the illustrations and text, by Dr. Goddard, whose competency for the un- 
dertaking is sufficiently well known. 

Art. XIX. JL Treatise on the Diseases of the Eye. By W. Lawrence, F. R. S., 
Surgeon Extraordinary to the Queen; Surgeon to St. Bartholomew's Hospital 
and Lecturer on Surgery at that Hospital; Surgeon to Bethlem and Bridewell 
Hospitals; and late Surgeon to the London Ophthalmic Infirmary. From the 
last London edition. With numerous additions and sixty-seven illustrations 
by Isaac Hays, M. D., Surgeon to Wills Hospital, Physician to the Phila- 
delphia Orphan Asylum, Member of the American Philosophical Society, 
&c. &c. &c. Philadelphia, Lea & Blanchard, 1843. 

The treatise of Mr. Lawrence has been for some time before the profession, 
and as is well observed in the advertisement by the American editor, "the cha- 
racter of the work is too well established to require a word of commendation, 
being justly considered the best we possess on the subject." 

The notes and illustrations, added by Dr. Hays, whose devotion to the study 
of diseases of the eye peculiarly fitted him for the task of annotating the work, 
and who, in addition to his own ample experience, has availed himself of the 
use of important matter, derived from the works of Mr. Mackenzie and others, 
are extremely valuable; some of these we shall briefly notice. 

The anatomy of the eyeball and its appendages, as well as the more important 
operations, are illustrated in the American edition by wood-cuts, well calculated 
to convey to the reader correct impressions on these subjects. Speaking of the 
intimate structure of the iris, the editor states that, the recent experiments of 

1843.] Lawrence on the Diseases of the Eye. 181 

Prof, Grimelli of Modena corroborate the opinion of Arnold, and concludes 
*' That contrary to the generally admitted opinion on the muscularity of the iris, 
as it appears to the author, this mem1)rane is composed of a turg-escible or erec- 
tile vascular tissue, in which arterial vessels predominate." 

In the chapter on the formation of an artificial pupil. Dr. Hays has extended 
and elucidated the account of Maunoir's operation, and given a detailed descrip- 
tion of one performed by himself, which cannot strictly be referred to either of 
the three modes described in the text, and which he calls by distortion. This is 
highly ingenious, and consists in a simple division of about one-fourth of the 
cornea, near its junction with the sclerotica, and allowing the iris to prolapse, 
which draws the lower edge of the pupil to the incision, at which point adhe- 
sion takes place. He was led to the performance of this operation in the case 
narrated, by "reflecting upon the general occurrence of prolapse of the iris in 
wounds of the cornea, with consequent synechia anterior, and drawing aside of 
the pupil." We have since had an opportunity of seeing him perform the same 
operation in another case, with the same result. 

In the twentieth chapter, some interesting remarks are made upon the ina- 
bility to distinguish colours, and a case is narrated in which this was not, as 
usual, a natural defect, but the result of disease, which by appropriate medical 
treatment was cured. 

In the chapter on cataract, Mr. Lawrence has altogether omitted an account 
of the catoptric examination of the eye, so important in the diagnosis of many 
affection^s of this organ. An omission, however, which has been fully supplied 
by the Editor, who gives us in treating on the physiology of the eye, the ration- 
ale of the method of examination, which we need not here notice; the remarks 
and cases appended to this chapter, illustrative of its value, we think it well to 
give entire, 

"In the diagnosis of cataract, the catoptric examination of the eye affords the 
most unerring test. 

" In the early stages of lenticular cataract the brilliancy and distinctness of the 
inverted image is diminished, it has no longer a sharp and well defined margin, 
but its outline appears shaded off. This image gradually fades with the increase 
of the opacity, and long before the cataract is mature the inverted image is ob- 
literated. The deep erect image is also indistinct in the advanced stages, the 
anterior surface of the capsule giving only a general reflection. 

"In capsulo-lenticular cataract the inverted image fades much earlier than in 
mere lenticular cataract, a very slight degree of opacity of the capsule sufficing 
to destroy its function of reflection. 

"Among the numerous cases, we have seen, in which we have derived great 
assistance in our diagnosis from the aid of the catoptric test, we shall relate two 
which will serve to show its utility and to justify the confidence we repose 
in it. 

"In September, 1839, I was invited by my friend. Dr. G. W. Norris, to exa- 
mine a mulatto man named Peter, in the Pennsylvania Hospital, who was sup- 
posed to be affected with glaucoma. The pupils had been dilated by the appli- 
cation of belladonna. There was opacity in both eyes, which was denser in 
some parts than in others. This opacity seemed more deep seated, than is 
usual in cataract, and its colour was of a greenish grey. Vision, was, however, 
quite as good, perhaps better, than might have been supposed from the degree 
of opacity. 

" On holding a lighted candle before the eyes, the three images were visible. 
The anterior upright image was natural in all respects. The deep seated up- 
right and inverted images were dull, their margins indistinct and of an unusual 
reddish tint. The inverted image in one eye, disappeared as the candle was 
moved opposite to the more nebulous portion of the lens, and when the observer 
looked at the eye of the patient obliquely, the inverted image seemed to have 
a double point like the letter W. ' I did not hesitate from these phenomena to 
pronounce it to be a case of cataract. 

182 BibliograpMcal Notices. [Jan. 

"A few days afterwards this man died suddenly, and we were afforded an oppor- 
tunity of examining his eyes. 

"The transparency of both capsules was impaired. A narrow portion of the 
posterior part of one lens, extending from near the margin to the centre was quite 
opaque, and on applying a needle to it we found it quite soft so as to be readily 
removed, leaving a depression. On carefully washing both lenses so as to re- 
move their superficial layers which were softened, as well as partially opaque, 
the remaining portion was found perfectly transparent and of a beautiful amber 
colour. This colour was the same whether the lens was viewed by trans- 
mitted or reflected light. 

"The second case was that of a man named Christian Minster, forty years of 
age, admitted into Wills Hospital, October 7lh, 1841. This man stated that 
he had recently come from the country, that he had been admitted in one of 
our public institutions, where he was pronounced to he labouring under cataract, 
and it was determined to operate upon him; but that being unwilling to submit to 
this he had eloped. A letter which he showed from his physician in the country, 
also indicated his disease to be cataract, 

" The opacity behind the pupil had certainly a great resemblance to that of cata- 
ract. The degree of vision he enjoyed corresponded to the degree of opacity — 
the independent and associate motions of the iris were tolerably active — and the 
patient saw best by twilight. 

"On applying the catoptric test, however, it was at once found to be a case of 
amaurosis, and not of cataract. The three images were visible and of their natu- 
ral appearance. The history of the case led me to ascribe the amaurotic affec- 
tion to congestion of some portion of the nervous apparatus, and a course of 
treatment corresponding to this view was directed, consisting of counter-irrita- 
tion to the back of the neck, purging, stimulating pediluviae, &c. Under this 
course he improved so rapidly that in a week he could read with one eye a dia- 
mond bible. He subsequently had a relapse, but by the application of cups to 
the head, pustulation with tartar emetic on the back of the neck, and afterwards 
ptyalism, he was completely restored. He was discharged cured in January 

The case of Michael McConville, related in the No. of this journal for Nov. 
1839, might have been adduced as a further exemplification of the value of this 
test. This man, who laboured'under amaurosis, was four times operated upon for 
the removal of cataract. 

In the chapter on Strabismus, much additional matter has been introduced; 
Dr. Hays thinks the operation useful when skilfully performed in cases which 
are judiciously selected, but not so generally successful as we have been led to 
suppose: he says, "the correctness of this inference will be at once assented 
to, when it is considered, that such a mania has prevailed among some sur- 
gons for operating, that they have seized upon every case suitable or not, and 
that almost everywhere, the greater number of cases have fallen under the knife 
of unprincipled operators, attracted to them by false statements of success 
widely circulated in the public papers, with the certificates of cases given to 
them by those whom they had duped." 

In the chapter upon fistula lachrymalis, the Editor states, the ordinary opera- 
tions described in the text, are rarely requisite for the re-establishment of the 
passage for the tears to the nose; that all cases in which the inflammation has 
not been so violent as to cause complete obliteration of the nasal ducts, may be 
cured by recourse to proper methods of dilatation, upon the same principles 
which would guide us in the treatment of stHctures elsewhere. In these re- 
marks he is borne out by the experience of Mi*. Travers. 

Sufficient has been adduced, to show the nature of the additions made by Dr. 
Hays, and to authorize us in recommending the work to all those who are desi- 
rous of obtaining correct information upon a class of diseases, the proper treat- 
ment of which is of the highest importance, but unfortunately by the mass of the 
profession in this country, almost wholly neglected. G. F. 


1843.] 183 







1. New Process for Anatomical Injections — In a letter addressed to the Academy 
of Sciences, Paris, July 12, 1841, M. Doyere gives the following account: — 
1 have employed, for nearly two years, a very simple process for obtaining fine 
injections. This process, which I believe likely to render some service to the ana- 
tomy of structure, and probably also to pathological anatomy, essentially con- 
sists in causing to enter in the same vessels, within a certain interval of time ^ two 
finely filtered saline solutions, which, by double decomposition, give an abun- 
dant and opaque precipitate. This succession of two injections is that which 
distinguishes my process from many others tried without success to obtain the 
injection of the capillary system by the same principle. I inject the second solu- 
tion, as soon as the first has passed from the arterial system into the venous and 
lymphatic systems. 

I have tried on animals a great number of insoluble salts, with a view to deter- 
mine those which would give the most satisfactory results. I prefer to all others 
the chromate of lead. 1 first inject the chromate of potass, and am convinced 
that the order of injection is a point not to be neglected. A blue colour may be 
obtained by the precipitation of Prussian blue; brilliant red by iodide of mercury; 
white by the carbonate or sulphate of lead. The first has better succeeded with 
me than the carbonates and sulphates of lime and baryta. 

The advantages which this process appears to me to possess over those in use, 
are above all to shorten the process of making fine injections, and to supersede 
any other preparation. It may be used with equal advantage cold or hot, in 
general or partial injection; the materials employed are unalterable, and may be 
consequently always ready. I will add, that the most minute injections required 
only a pressure which was evidently less than that of the heart's action. M. 
Poiseuille, to whom 1 made the process known several months since, in order 
that he might make use of it in his particular researches, has constructed an in- 
strument by the assistance of which he can inject either liquid with that degree 
of pressure he considers proper. 

By the assistance of this process, I have more than once succeeded in injecting 
by the femoral artery in a single operation, and in a few minutes, the capillaries 
of the muscular system in an entire animal, the adipose and cellular systems of 
the white and gray matter of the brain, of the conjunctiva, of all the mucous mem- 
branes, intestinal villosities, &c. The capillaries thus injected by the chromate 
of lead are more filled, especially after drying, than by the injections of size, but 
less than by those of varnish {vernis)\ there also remains some doubt in my mind 
relative to the actual diameter of the latter canals. Those which run parallel to 
each primitive muscular fasiculus, to the number of four or six, appeared to me 
to possess, in the dog, ^J-gth or^J-_th of a millimetre; but it is possible that their 
dimensions had been reduced by the action of one or the other of the two sola- 

184 Progress of the Medical Sciences. [Jan. 

tions employed, or that they had not been sufficiently filled. I am now engaged 
in determining the relation which exists between the size of injected vessels, 
and their size during life. — Microscopic Journal^ from Comptes Rendus^ July 1841. 

2. Anatomy of the Par Vagum and Nervus Accessorius. — There is an interest- 
ing paper on tJiis subject in the Edinburgh Med. and Surg. Journ. for Oct. last, 
by Jas. Spence, Esq. 

It is well known that a considerable difference of opinion has of late existed 
'among anatomists and physiologists regarding the exact functions of the par 
vagum; some maintaining that it is entirely sensiferous and incident, while others 
have maintained that it also contains a few motor filaments. Scarpa, Arnold, 
Bischoff", Valentin, &c., have asserted that all the motor filaments of the pha- 
ryngeal and laryngeal branches of the par vagum actually come from the spinal 
accessory; while Miiller, John Reid, Volkmann, &c., maintain that a few motor 
filaments are bound up in the par vag-um at its origin, though they admit that the 
greater number of the motor filaments found in the trunk of this nerve, as it lies 
in the neck, are derived from the spinal accessory. Mr. Spence has proved, by 
accurate and minute dissections, that a few of the filaments of the par vagum are 
non-ganglionic or motor, passing over the superior ganglion of this nerve, and 
joining themselves to the internal root of the accessory. The white nervous cord 
so formed by this junction can be traced down over the inferior ganglion of the 
vagus to which it gives one or two delicate filaments, and at last seems princi- 
pally to pass into the formation of the inferior laryngeal nerve. — Lond. and Edin, 
Month. Journ. of Med. Sci. Nov. 1842. 

3. On the Influence of Lactation in preventing the recurrence of Pregnancy. 
By T. Laycock, M. D., Physician to the York Dispensary. — The influence of 
lactation, in preventing the recurrence of pregnancy, has never yet been fairly 
estimated. It is generally taken for granted, indeed, that pregnancy will not oc- 
cur during lactation, as well as that prolonged lactation must be injurious to the 
health. Neither of these opinions are strictly correct. 

Mr. Roberton of Manchester made inquiries of 100 married females, and as- 
certained that one-half, or 50 per cent, conceived during lactation. Mr. Rober- 
ton, however, did not ascertain how often pregnancy took place during suckling 
— an important fact to be known, as will be seen from the following inquiries I 
have made on this subject. 

As it has been objected to Mr. Roberton's inquiries, that they were made 
amongst the lower or labouring classes of a manufacturing town, I wrote to one 
or two professional friends, in agricultural districts, to request their assistance; 
Mobile, at the same time, I made inquiries in York, where the population can be 
considered neither manufacturing nor agricultural. Inquiries were made of 135 
married females, with the following results: — 209 pregnancies took place during 
766 lactations, or at the rate of 1 in 3.66, or about 27 per cent. 

The 209 pregnancies occurred in 76 females as follows: — 

■«.T r T-> -fcT r /-lu-i No. of times 

No. ofFe- No.ofChil- regnant du- Average, 

males. dren. rfng^actation. 

30 163 30 1 in 5.4 

12 65 24 1 in 2.6 
10 78 30 1 in 2.6 

13 93 52 1 in 1.8 

3 25 15 1 in 1.6 

4 29 24 1 in 1.2 
2 14 14 1 in 1 

2 25 20 1 in 1.3 

76 492 209 1 in 2.36 

The average duration of lactation in the 135 females was 13 months nearly; 

1843.] Anatomy and Physiology. 186 

of the 76 it was 14.4 months. It will be seen, that in 30 of the 76 who became 
pregnant dnring- lactation, pregnancy so occurred only once; so that, for practical 
purposes, these might be deducted. This reduces the nu^mber of females who 
conceived while suckling, to 46, or 33.9 per cent., being nearly 1 in 3. This is 
below Mr. Roberton's estimate. If, however, the whole number be taken, the 
proportion is 56 per cent., being higher than Mr. Roberton's estimate. From 
(he inquiries I made, it appeared very evident that there were two classes of fe- 
males. In the one, the pregnancy during lactation was the rule; in the other the 
exception. Of the former class there appear 19 only in the 135, or 1 in 7. These 
19 females averaged five children each; nine of them had 46 children, and always 
became pregnant during lactation; ten had 48 children, and each of the ten es- 
caped, becoming pregnant only once during lactation. The period of lactation, 
at which pregnancy took place, varied from three months to two years. The 
average in 108 instances was 12^ months. The average age of 135 females at 
the time of marriage was 22 years; the average number of children weaned 5.7. 
Some remarkable cases occurred to me in the course of my inquiries. One indi- 
vidual had an infant at the breast during the whole period of pregnancy, and 
continued lactation after parturition; so that she had two nursing at once. Ano- 
ther female in a village near York, gave the breast to one of her sons until he 
was eight years old, and a strapping fellow he was at five-and-twenty, when I 
saw him. The same person nursed three children for two years each. 

She never became pregnant during lactation. Neither did another female who 
nursed three children for two years, and four for a year and a half. Another in- 
dividual who had six children had always the catamenia during lactation, but 
never became pregnant before weaning. To the inquiry as to the state of the 
health during lactation, the answer was almost invariably "good." Often the 
individual observed, that she was always in the best health while nursing. 

Having been assisted in these inquiries by several professional friends, 1 could 
not trespass upon their time by requesting answers to a numerous set of ques- 
tions. In any fiiture inquiries, the condition in life should be actually discrimi- 
nated, and the state of health, where pregnancy occurred during lactation, parti- 
cularly inquired into. My own opinion is, that where this occurs as an excep- 
tion^ it will be found the health of the individual has been below par; so that 
lactation has been irregularly performed. It is not unlikely, indeed, that the great 
fecundity amongst the lower classes, and also the fecundity observed after a fa- 
mine or destructive epidemic, may be dependent upon this preponderance of 
the ovarian over the mammary influence. 1 believe, however, where pregnancy 
during lactation is the rule, there will be rather a full state of health, the femi- 
iiine characteristics of the individual strongly marked, and great fecundity. 
This peculiarit}' of the female seems hereditary. I traced it to the third genera- 
tion in one family, and to the second in three or four. It is an interesting subject 
for further inquiry.— i)wi/m Medical Press, Oct. 26, 1842. 

4. Additional Rt marks on Fihrine. By Martin Barrv. — On examining coagu- 
lated blood. Dr. Barry finds that it contains discs of two different kinds; the one 
comparatively pale; the other very red. It is in the latter discs that a filament 
is formed; and it is these discs which enter into the formation of the clot; the 
former, or the pale discs, being merely entangled in the clot, or else remaining 
in the serum. He thinks that the filament escaped the notice of former observers, 
from their having directed their attention almost exclusively to the undeveloped 
discs which remained in the serum, and thus conceived that the blood-discs are 
of subordinate importance, and are not concerned in the evolution of fihrine. 

To render the filament distinctly visible. Dr. Barry adds a chemical re-agent 
capable of removing a portion of the red colouring matter, without altogether 
dissolving the filament. He employs for this purpose chiefly a solution of one 
part of nitrate of silver in 120 parts of distilled water; and sometimes also the 
chromic acid. He admits that the use of these re-agents would, on account of 
their destructive tendency when concentrated, be objectionable as proofs of the 
absence of any visible structure; but as the point to be proved is, that a certain 

186 Progress of the Medical Sciences. [Jan. 

specific structure does exist, he contends that the same appearance would not 
equally result from the chemical actions of re-agenls so different as are those of 
chrome and the salts of mercury and of silver. After the appearance of the fila- 
ment, thus brought to light, has become familiar to the eye, it may be discerned 
in the blood-discs when coagulation has commenced, without any addition what- 
ever. Those blood-discs of the newt, which contain filaments, often assume the 
form of flask-like vesicles, the membranes of which exhibit folds, converging 
towards the neck, where, on careful examination, a minute body may be seen pro- 
truding. This body is the extremity of the filament in question, its protrusion 
being occasionally such as admits of its remarkable structure being recognised. 

The author proceeds to describe various appearances which he has observed in 
the coagulum of the blood, and which strongly resemble those met with in the 
tissues of the body, and are obviously referable to a similar process of formation. 
He bears testimony to the accuracy of the delineations of coagulated blood given 
by Mr. Gulliver. One of the most remarkable phenomena discovered by the au- 
thor in the coagulation of the blood is, the evolution of red colouring matter — a 
change corresponding to that which he had previously observed to take place in 
the formation of the various structures of the body out of the corpuscles of the 
blood. He considers the production of filaments as constituting the essential cir- 
cumstance in coagulation. 

He conjectures that the notched or granulated fibres noticed in the blood by 
Professor Mayer, may have been of the same kind as the flat, grooved, and com- 
pound filaments described by himself; but he thinks that in that case, Mayer's 
explanation of their mode of origin must be erroneous; for they may be seen 
to be produced by a portion of the blood not mentioned by him — namely, the 

Mr. Addison's discovery of globules in the uppermost stratum of inflammatory 
blood, and of their influence in the formation of the buffy coat, is confirmed by 
Dr. Barry, who remarks that these globules are altered red blood-discs. That 
the blood corpuscles are reproduced by means of parent-cells, as suggested by 
Mr. Owen and by the author, is confirmed by the observations of Dr. Remak; 
but the author had long ago indicated a division of the nucleus as being more 
particularly the mode of reproduction, not only of those corpuscles, but of cells 
in general. With this conjecture the observations of Remak on the blood-cor- 
puscles of the foetal chick fully accord. Whether the author's further specula- 
tion — namely, that the parent-cells are altered red blood-discs, is correct, still re- 
mains to be seen. 

The phenomenon of the "breaking off" short," or notching of the fasciculus 
of a voluntary muscle in a transverse cleavage of the fibre, is regarded by Dr. 
Barry as a natural consequence of the interlacing of the larger spirals, which 
he has described in a former paper; the fracture, in proceeding directly across 
the fasciculus, taking the direction in which there is least resistance. 

The position of the filament in the blood-corpuscle is represented as bearing 
a striking resemblance to that of the young in the ovum of certain intestinal 
worms, the filaments of which are reproduced by spontaneous division. The 
author subjoins the following quere, "Is the blood-corpuscle to be regarded as 
an ovuml" — Proceedings of Royal Society, 

5. Minute Anatomy of the Spleen. — M. Bourgery, who has recently devoted 
much time to microscopic investigations of the minute anatomy of the frame, 
having examined a large number of human and other spleens, states that they 
consist of vesicular membranes, blood-vessels, floating vascular corpuscles, a 
granulo-capillary apparatus, (champ granulo-capillaire,) a splenic fluid, splenic 
glands, lymphatic vessels, nerves, cellular tissue, and an enveloping membrane. 
The first five of these compose the vesicular apparatus, the sixth and seventh 
the glandular, and the last three the general texture of the organ. 

The splenic vesicles are found in every part of the spleen, separated by mem- 
branous walls, and of a spheroid or ovoid shape when the spleen is fully injected, 
of an irregular poly-hedral figure of from five to ten sides, when the organ is 

1843.] Anatomy and Physiology. 187 

inflated. The former is probably the true shape, as during life the liquids fill 
the vesicles, glands, and vessels. They vary much in volume, not only in dif- 
ferent animals, but in the same spleen. In man they are smaller and more 
regular. In general, their medium diameter is from one to one and a quarter of 
a millimetre, and they do not vary one-third of this dimension more or less. 
These vesicles do not form simple cavities, being traversed by vessels covered 
with the enveloping membrane, which form crescentic folds to the extent of one- 
third, one-half, or the entire diameter of the vesicle, by which a series of subdi- 
visions of the cavity are formed, at the bottom of which are found the glands, 
granules, and capillary arborisations in relief. They have two kinds of orifices, 
one of communication, inter se, which is irregularly circular, veith its edges 
formed by a fold or reflected membrane from the parietes. The larger vesicles 
have two or three, the smaller ones have one at least, this free communication 
between the vesicles enabling the anatomist readily to inflate the organ not only 
by the veins, hut by any opening made on its external surface. The orifices of 
communication with the veins are not so numerous as those just described; some 
vesicles will have two or three, while several others close by have not one be- 
tween them. These orifices are circular or ellipsoid, and possess an incomplete 
crescentic valve. They are about one-twelfth of a millimetre in diameter in man. 
They form the absorbent mouths of veins of the same size, which are connected 
with those of the intervesicular spaces. 

The intervesicular spaces are formed by the separation of the enveloping mem- 
branes, and contain the vessels and splenic glands; their size depends on the 
degree of repletion of the vesicles. These spaces are enlarged irregularly be- 
tween several vesicles, and are filled with glands. 

The enveloping membrane constituting the parietes of the vesicles, is one 
continuous membrane throughout the entire extent of the spleen, and may be re- 
garded as divided into a number of small isolated ampullae, and supported by the 
ramifications of the vessels and by the glands. The organisation of the vesicu- 
lar membrane is very complicated, as it encloses the granulo-vascular membrane 
with its thick network of blood-vessels and lymphatics. 

M. Bourgery divides the blood-vessels into three orders — the splenic, interve- 
sicular, and the vesicular. The splenic artery and vein divide into three or four 
branches, which pass directly to the surface of the organ; the veins, which are 
much the larger, are pierced with a number of small foramina, opening into the 
venulas of the spaces; the terminal veins according to the length of their canals, 
end in a succession of cellules, separated by vascular bands, the organic compo- 
sition of which is absolutely identical with that of the vesicles in which they 
terminate. The intervesicular vessels, arising from the preceding, are distributed 
to the glands and intervesicular membrane in the spaces. The vesicular vessels 
form the falciform folds already spoken of in the interior of the vesicles. Their 
branches project into the cavity to be distributed to the floating vascular corpus- 
cles, resembling a bunch of grapes. On the fundus of the membrane, the ter- 
minal capillaries form the granulo-vascular network with the lymphatics. There 
are two kinds of veinules, the capillicules of the common network, and the 
veinules of absorption, which are much larger than those that open into the ve- 
sicular cavities. All the small vessels of the spleen, whether of the spaces or 
vesicles, are distinguished, when distended, by a continued series of swellings 
and ijontractions, which give them a well-marked knotted aspect. 

The floating vascular corpuscles are contained in the interior of the vesicular 
cavities, where they depend, as from a pedicle, from the terminal branches of the 
capillary lymphatics and blood-vessels. They are formed by a lenticular nucleus, 
whence spring in the turgid state, small aigrettes radiating towards the circum- 
ference. These aigrettes are composed of a filament terminated by small bril- 
liant spherules, collected in the form of a chaplet. The corpuscular nuclei are 
of unequal shape, and about fifteen to sixteen times the size of the diameter of 
the blood globules, and their capillaries have a calibre of 3.100 of a millimetre. 
The granulo-vesicular membrane is composed of two elements: first, of pale 
spherical granules in juxtaposition, equal in diameter to four or five globules of 

188 Progress of the Medical Sciences. yan. 

blood, and of arterial, venous, and lymphatic capillaries. The splenic liquid or 
blood appears to be the product of elaboration by the floating corpuscles and the 
g-ranulo-vesicular membrane; it is deposited in the vesicular cavities, whence it 
is taken up by the absorbent veins of its parietes. It is thick, viscid, of a red- 
dish brown colour, and under the microscope it appears to be composed of seve- 
ral kinds of globules held in suspension in a yellowish and unctuous liquid — 
viz., lenticular globules — some red, which do not appear to differ from the ordi- 
nary blood globules, others colourless, and whitish irregular globules, resembling 
those met with in the chyle and lymph. 

The splenic glands united by cords of the same substance, with the ramifica- 
tions of the vessels, fill up the intervesicular spaces; their greatest diameter in a 
state of repletion is about a quarter of a millimetre in man. In a bullock's spleen, 
where they are about two millimetres in diameter, they can be seen with the 
naked eye in the form of brown or whitish corpuscles. M. Bourgery believes 
these to be the glands spoken of by authors as the vesicular glands of Malpighi. 
These glands isolated or agglomerated in the spaces according to their size, are 
united by their cords into the form of chaplets, and receive a great number of 
lymphatics and blood-vessels. When magnified to 200 or 500 diameters, they 
appear to consist of granules and infinitely small capillaries. The lymphatics 
form a network on the surface of the gland, whence an afferent vessel penetrates 
its substance, subdivides into innumerable ramusculae, forming the principal part 
of the gland, and terminating in an efferent vessel, which passes to the vessels 
of the intervesicular space. From these facts, M. Bourgery concludes them to 
be microscopic lymphatic glands. The microscopic lymphatic vessels arise 
from the granulo-capillary membrane, where they form a very close network; 
they unite to compose fifteen to twenty larger trunks, which enter the glands of 
the spaces. Their diameter is from 5. to 8.100 of a millimetre. The larger 
branches are provided with valves, and have enlargements, which at the points 
of anastomosis, resemble rudimentary glands, as if they were not only vessels 
for carrying the lymph, but also bore a part in its elaboration. 

According to Malpighi, the spleen was composed of cellules separated by 
spaces; in the cells existed granulations pendent from the extremities of the 
arteries and nerves. The veins and arteries opened into the cellules by gaping 
orifices. The spaces were formed by a parenchyma, formed of fibrous and mus- 
cular bands, and contviined a thickened and extravasated blood. Ruysch ad- 
mitted the existence of the membranes, but denied that of the fibres and cellules, 
and assigned another use to the granulations. Winslow spoke of a cottony 
tissue, and admitted the cellules and granulations, but did not allude to the vas- 
cular capillaries. Haller acknowledged only the cellules and granulations; a 
little later Assolan denied the existence of the cellules, and still later Meckel 
wrote against the cellules, and Cruveilhier against the granulations in man. 

From these details, it appears that the spleen is composed of two distinct ap- 
paratuses, the vesicular and the glandular, divided into little organules, in juxta- 
position throughout the entire organ. Of these, the vesicular apparatus con- 
stitutes three-sixths of the spleen; the glandular two-sixths; the remaining 
one-sixth being formed by the vascular arrangement. The vesicular apparatus 
or succession of vesicles, is continuous throughout, inter se by orifices of com- 
munication, and comprises the splenic veins, the corpuscles, and the granulo- 
capillary membrane. It constitutes a long canal, everywhere folded on itself, 
and divided by vascular bands into myriads of little cavities to increase the sur- 
faces. The texture of these vesicles and the nature of the liquid they contaia 
cause them to be regarded as an apparatus for the elaboration of blood. 

The glandular apparatus is composed of glands and lymphatic vessels. It 
consists of a tortuous chain of glandules connected by cords of the same sub- 
stance, and situated betvi-een the vesicular ampullae. It may be regarded as one 
large lymphatic gland, broken down into smaller ones, in order to surround the 
vessels throughout the entire extent of the spleen. The capillary blood-vessels 
assimilate somewhat in texture to the organ itself, the veins forming part of its 
tissue, and participating in its functions, while the lymphatics appear to be not 

1843.] Anatomy and Physiology. 189 

merely vessels for transmitting the lymph, but at the same time organs for ela- 
boration. The anatomical arrangements are the same throughout the mammiferee, 
but in man they are more precise and defined, marking the perfection of the 
organ, which is much more simple in its organisation in animals. — Prov. Med, 
Journ., Oct. 1, 1842, from Gazette Med. de Paris, June 1842. 

6. Nature of the fat substance (fMilk.—M. Romanet asserts that the globules 
of the milk are entirely formed of butter', which exists as a pulp enveloped in a 
white, translucent, elastic, and resistant pellicle; and that this cyst is broken in 
churning, by which the butter is allowed to escape, and the pellicles floating 
about separately constitute the white particles which give consistence to the 
buttermilk. — Comptes Rendus, April 4, 1842. 

7. Virey'*s Objections to Liebig's Theory of the Uses of Respiration and of 
Food. — Liebig maintains that the chief use of the food is to supply carbon and 
hydrogen, which, uniting with the oxygen absorbed from the air, give rise to the 
generation of animal heat. He consequently holds that there is a certain fixed 
relation between the amount of food consumed, and the quantity of carbon and 
hydrogen thrown off at the lungs. M. Virey opposes this theory, as contrary to 
common observation, as, even though it be allowed to be applicable to mamma- 
lia, birds, and reptiles, it is by no means to those animals which respire by means 
of branchiae. Thus all animals with branchiae consume but little oxygen, com- 
paratively speaking, and yet many of them devour very great quantities of food. 
Even the largest and most voracious of the reptiles, as the alligators, crocodiles, 
&c., which devour enormous quantities of food, under a burning climate too, 
respire feebly with their vesicular lungs, and consume but little oxygen. 

Fishes, whose blood is but imperfectly oxygenated by the branchial apparatus, 
are perhaps among the most voracious of animals, and yet, according to Liebig's 
theory, they ought to eat little, because they consume little oxygen. 

The same holds true of the Mollusca. The cuttle-fish, buccinum, strombus, 
murex, &c. grow to a large size; but their respiration is very imperfect, and yet 
they are great flesh-eaters. The Crustacea, again, as the crabs, lobsters, &c., 
grow rapidly, because they are great eaters; but their branchial apparatus is not 
fitted to consume much oxygen. 

In all these animals assimilation takes place very rapidly, notwithstanding 
their feeble respiratory powers; and they are, besides, by no means deficient in 
activity or muscular powers, though their flesh be but feebly azotized or anim*l- 
ized, and their blood is always cold. 

If it be one of the characters of vitality, that the more perfect this principle 
is, the greater is the number of germs, or eggs, or fcBtuses produced, then, quite 
contrary to Liebig's theory, the number of germs produced is in the inverse ratio 
of the perfection of the respiratory functions. Fishes and mollusca deposit their 
spawn or eggs by millions; but the mammalia, and even the birds, whose respira- 
tory functions are the most perfect, are in this respect infinitely behind these. On 
the other hand, it is seen that the number of germs or eggs is rather proportioned 
to the nutrition received; for the amount of food taken is not proportioned to the 
respiration in the animal kingdom. 

M. Virey therefore concludes, that the vital force or central nervous energy 
has more to do with the production of animal heat than the consumption of car- 
bon at the lungs, and this for three special reasons; — 1st, Because a fecundated 
egg resists a freezing temperature longer than one which has not been fecundated. 
2d, That a hybernating insect, reptile, or animal, or even trees during winter, 
by the sole influence of a vital power, resist a freezing temperature, whereas the 
same animals, if dead, would be instantly frozen. 3d, That many mammalia 
and birds keep themselves warm even in the most rigorous winters under the 
Pole, not in consequence of a greater amount of oxygen consumed, nor by a 
greater amount of muscular activity, but in consequence of a more abundant 
highly azotized or animalized nourishment.— /owrn. de Pharm., May, 1842. 
No. iX.— January, 1843. 13 

190 Progress of the Medical Sciences, [Jan. 


8. Observations on Discoloration of the Skin from the internal use of Nitrate of 
Silver, and on the means of preventing and removing that effect. By Charles 
Patterson, M. D.— Nitrate of silver is undoubtedly a medicine of great service, 
especially in the treatment of various spasmodic diseases, but the danger of pro- 
ducing discoloration of the skin by its internal administration, prevents its em- 
ployment as extensively as might otherwise be the case. It must therefore be 
an object of importance to devise some means of preventing that untovv^ard effect. 

Dr. Patterson first quotes the opinions of Dr. A. T. Thomson on the subject, 
who supposes that the nitrate is taken into the circulation undecomposed, and, 
arriving in that state at the capillaries of the skin, is there decomposed, and con- 
verted into chloride of silver, which is deposited in the rete mucosum. The 
chloride, he says, acquires a gray leaden colour from its contact with animal 
matter; and, as it is insoluble, it is incapable of being reabsorbed, is fixed in 
the rete mucosum, and a permanent stain is given to the skin. Dr. Thomson 
suggests that, by ordering diluted nitric acid, at the time of administering the 
salt, its decomposition may be effected. 

In opposition to these views of Dr. Thomson, Dr. Patterson quotes various 
experiments which he has made, and then brings forward his own conclusions, 
viz. that the chloride of silver is not the colouring ingredient on which the 
blackness of the skin depends; but that the discoloration of the skin is most 
probably owing to the decomposition of the chloride of silver circulating in the 
cutaneous tissue through the chemical action of the sun's light, and the depo- 
sition there of its metallic basis. All persons are not subject to this accident; 
for the influence of the sun's rays can only be effective in those cases where the 
cutis is more than ordinarily vascular and is clothed with a thin transparent 

The permanence of the stain is not easily accounted for; but it would seem 
that the metals constitute one class of substances for which the absorbents have 
no attractive affinity, as is shown in those instances where ballets have remained 
for years in the body, in the use of metallic ligatures, and in the internal exhibi- 
tion of quicksilver. 

Means of Prevention.— Nitric Jlcid. — Dr. Patterson considers that the contem- 
poraneous administration of nitric acid, with the intention of preventing the de- 
composition of the nitrate of silver, must be entirely useless. The nitric acid 
undergoes decomposition in its passage through the circulation, and consequently 
can hardly reach the surface of the body to influence the chemical changes there 
in operation: and even if it did, and met with nitrate of silver there, its action 
would be to promote and not to retard the formation of the chloride of that metal; 
for this reason, that coming into contact with the soluble muriates, it would de- 
compose the muriatic acid, with the evolution of free chlorine. 

The conclusion to which Dr. Patterson comes on this subject is, that the only 
way to prevent all risk of discoloration, would be to substitute for the nitrate, 
some preparation of silver not liable to be acted on by chlorine, or the sun's 
light. And happening to be employed in some photographic experiments, his 
atlention was directed to the property displayed by solutions of the iodide of 
potassium in rendering nitrate of silver insensible to the influence of the sun's 
rays. When a piece of paper was washed with solution of nitrate of silver, and 
then immediately immersed for a few seconds in a solution of hydriodate of 
potash, its colour, even when exposed to the strongest sunshine, remained un- 
altered. It was evident, in this process, that the hydriodate and the nitrate w^ere 
both decomposed, and that an ioduret of silver was the result. It then remained 
to be determined whether, in contact with animal matter or medicinally adminis- 
tered in combination with chemical agents, it would retain that power. 

To ascertain this point various experiments were executed; — the ioduret was 
mixed with different animal and vegetable substances, and submitted to the ac- 

1843.] Materia Medica and Pharmacy, 191 

tion of different chemical agents, and then exposed to the action of the sun, with- 
out, however, producing the least change of colour. 

Having thus satisfied himself as to the chemical habitudes of the ioduret, Dr. 
Patterson's next endeavours were directed to ascertain its therapeutic effects. 
The first and principal class of diseases in which opportunities were afforded of 
administering it, were those various stomach affections to which the Irish pea- 
santry are so very liable, and in which the internal use of nitrate of silver has 
been found to be most generally successful. They, therefore, afford the best 
criterion whereby to judge of the comparative efficacy of the ioduret. In such, 
a number of which Dr. Patterson relates, it proved almost uniformly beneficial. 
In epilepsy the result was not so satisfactory; but as the medicine was only 
administered in two cases, it has not had a fair trial in that disease. In hoop- 
ing-cough it had variable success, but where that complaint was uncomplicated 
with fever or bronchitis, the ioduret appeared to produce an immediate improve- 
ment in the spasms, and hastened the final abatement of the congh. Sufficient 
time, however, has not yet been afforded, to allow of any definite conclusion to 
be come to on the subject. 

Removal of discoloration of the Skin. — Dr. Patterson considers that "there can 
scarcely be a doubt that in those cases, where the skin has become discoloured 
from the long use of nitrate of silver, the discolouration may be removed by the 
internal and external employment of suitable preparations of iodine." 

The following is the formula which Dr. Patterson employs for the administra- 
tion of the ioduret of silver. 

K. lodureti Argenti, Nitratis potassas, aa gr. x., Tere simul ut fiat pulvis 
subtil, dein adde Pulv. glycyrrhizos ^ss., Sacchari albi 9j., Mucil. arab. q. s. 
M. — Fiant pil. xl. quarum sumat aeger j. ter in die. — Med,. Chirurg. Rev., Oct. 
1842, from Dublin Med. Press, Aug. 24, 1842. 

9. Creasote as a Therapeutic £gent. — An interesting paper on this subject 
was read before the Medico-Chirurgical Society of Edinburgh, in July last, by 
Dr. Cormack; an abstract of which we copy from our esteemed cotemporary 
the London and Edinburgh Monthly Journal nf Medical Science, (Oct. 1842.) 

" Nature of its Action. — Dr. C. has satisfied himself, by experiments on 
the low^er animals, that creasote, in large doses, is a narcotico-acrid poison; and 
that it resembles prussic acid in its sudden depressing action on the heart, as 
well as in the temporary nature of its toxicological operation. In medicinal 
doses, it is almost immediately sedative and calming; but these effects are of 
short duration; so that it is a drug which requires to be given in of ten-repeated small 

" I. Internal Administration. — Use in nausea and vomiting. — Creasote is 
one of the best medicines which we possess for stopping vomiting. In the 
vomiting of pregnancy, an affection so distressing to the patient, it seldom fails. 
If the sickness come on regularly after rising in the morning, Dr. C. prescribes 
two or three drops to be taken five or ten minutes before getting out of bed. 
This generally proves effectual; but if it does not, the patient ought to be di- 
rected to repeat the dose in two hours. In more troublesome cases, when the 
sickness occurs at intervals during the day, one or two drops should be given 
every two, three, or four hours. Dr. C. has ordered it in a great many cases of 
this kind; but as it is only recently that he has kept accurate memoranda of 
them, he only communicated the result of his last eleven cases. Nine were com- 
pletely relieved; one (a dispensary patient) was lost sight of, but supposed 
to be relieved; and another was in no degree improved. She was afterwards 
successfully treated by two drop doses of the medicinal prussic acid. 

" The sickness and vomiting following a drinking debauch Dr. C. saw speedily 
relieved in two instances, by one dose of four drops. In January, 1837, Mr. 
Waugh, (then surgeon and apothecary in the High Street of Edinburgh), told 
him that he had relieved several individuals in a similar state, by small doses 
of creasote; but that in others he had tried it without any good effect. 

*' Jn sea-sickness, Dr. C. had only one opportunity of seeing its effects. Case. 

192 Progress of the Medical Sciences. [Jan. 

— Last summer, when going up from Edinburgh to London by sea, he observed 
when getting under way, a gentleman leaning over the side of the ship very 
siclc, beside whom was a bottle smelling strongly of creasole. It turned out, 
that he was a great martyr to sea-sickness, and had been advised by an apothe- 
cary, to whom he had applied for some remedy to be provided with, to take the 
creasote mixture which attracted Dr. C.'s attention; but that it had had an etfect 
directly {he opposite of what was intended; for no sooner did he swallow the 
first dose, than he was seized with retching. Upon the following day the 
weather was rough, and the creasote gentleman became exceedingly sick. In 
desperation he applied again to the reputed specific, when the very same dose 
that had on the previous day made him squeamish and sick, on this trial almost 
entirely relieved him. The quantity of creasote contained in his mixture was 
not ascertained. It is well worthy of notice^ as a general remark^ that creasote 
though excellent in allaying vomitings often excites it when it dues not exist. 
Vomiting is caused by creasote very frequently in cases where the dose is too 
large for the individual. If the statements of many can be relied on, it seems 
worthy of trial as a remedy in sea-sickness. 

"In vomiting coniiected with hysteria^ creasote proves a very valuable remedy, 
and so far as Dr. C.'s experience goes, he is inclined to think, that Dr. PJlliot- 
son and others, who have recommended it very strongly in this class of f^ases, 
have not done so without sufficient cause. In at least ten cases of this kind, Dr. 
C. has tried it in doses varying from two to eight drops, and in all, excepting 
one, it proved an admirable medicine, not only relieving the vomiting, but also 
apparently, in most instances, calming the nervous excitability. In the case in 
which it apparently did no good, the dose could not be increased beyond six 
drops thrice a day, on account of the vertigo Vv^hich it occasioned. The patient 
w^as ultimately much benefited by sponging with cold water, and taking four 
grains of the saccharine carbonate of iron three times a-day. Case. — Patient — 
A young woman, exhibiting many of the anomalous symptoms so common in 
hysteria. When fi.rst visited, she was emaciated, weak, nervous to a distressing 
degree: stated that she vomited her food, and had done so for ten days, but had 
had sickness in the mornings for a much longer period. She had l3een trying 
various tonics. None of them did her any good, and they were generally re- 
jected soon after they were swallowed. Dr. C. ordered her to breakfast in bed, 
and that sparingly, on the morning following his visit, and half an hour before 
doing so, to take a dose of a mixture, containing three drops of creasote, in acetic 
acid. After her meal, she had only slight nausea. She sponged her chest with 
vinegar and water, and before a light dinner, repeated the dose, but had a good 
deal of vomiting, though not so much as usual. As the creasote had produced no 
giddiness .or uneasiness of any kind, the quantity was increased on the follow- 
ing day to five drops before breakfast and dinner. For a week after this, she 
had neither nausea nor vomiting; but both having then slightly returned, for five 
days the dose was increased daily a drop, till at last, she was taking ten drops 
twice a-day. From this time the vomiting did not return for three weeks, during 
which time she persevered in the medicine, and under its use, daily gained 
strength and flesh; the catamenia, which had formerly been scanty, became 
much more abundant. As she now complained of headache, and attributed it to 
the creasote, it was discontinued, and the saccharine carbonate of iron substi- 
tuted, in doses of four, and afterwards five grains, three times a-day, in pills 
made up with the extract of gentian. She continues to use the iron, and has 
latterly, with great benefit, taken the shower-bath. Once or twice the vomiting 
has returned, and been promptly relieved by the creasote. In this case, the 
creasote did more probably than relieve the vomiting. It is, however, proper 
to state, that along with the creasote, from the commencement of the treatment, 
great attention was paid to the bowels, which had formerly been neglected. She 
took the compound aloes and assafcelida pill so as to have at least one stool daily, 
whereas formerly, she rested satisfied with two, or even with one a week; this 
of itself must have greatly contributed to the cure. 

"In all of the hysteric cases of vomiting, there existed constipation, which 

1843.] Materia Medica and Pharmacy. 193 

was actively dealt with; hut as in the case now detailed, the vomiting was re- 
lieved hy the creasote, before the purgative treatment could have developed its 
effects. From a number of cases, creasote appears to be valuable in hysteria, 
not only for the vomiting, but also in assisting to control many of the fantastic 
and distressing symptoms of this Protean malady. 

" In vomiting from various causes not yet specified^ creasote may be used with 
great benefit. In about twenty or thirty such cases Dr. C. has tried it with ad- 
vantage. Of thirteen cases lie has kept notes. Seven of these were phthisical. 
Relief was afforded in five of them. In the other two, it seemed to do no good 
whatever. In one of the seven successful cases, after morphia, strong coffee 
and other things which used to succeed with the patient, had failed, a dose of 
three drojjs stopped the retching in as many minutes. In three of the thirteen 
cases it was given to stop vomiting, caused by taking croton oil in neuralgia, 
and in every instance succeeded, though in one of the instances fifteen drops 
were required to be taken within half an hour. This is the largest quantity of 
creasote which Dr. C. administered within so short a time. In two of the thir- 
teen cases, the patients were lost sight of; but the affections were supposed to 
be hysteria, or pregnancy. The result of the first doses was good. One of the 
cases may be briefly detailed. Case. — A. E., a boy of about ten years of age, was 
under the treatment for tape worm, and had vomited one or two days before he 
was seen. During that and the preceding day, he had very severe vomiting, 
and had been unable to take either food or medicine. At the time of the first 
visit, he had retching every ten minutes. Creasote fortunately being at hand, 
one drop was immediately administered in a little mucilage. This did some 
good. The dose was repeated in ten minutes, and during the following hour he 
had neither vomiting nor retching; but at the end of this period, there being a 
return of the symptoms, a third dose was given. After this, they did not recur 
during the following eight days that the patient was under observation. Dr. C» 
saw this case along with Dr. David Macfarlane, now at Drymen. Case. — The 
following case, which has been communicated by Professor Simpson, may be 
mentioned in this place. Some years ago he operated on a man at Falkirk for 
strangulated hernia. Great vomiting ensued, which did not yield to opium, 
though given in large doses, and a mustard blister was also applied over the 
stomach, without any good effect. One dose of two drops of creasote completely 
relieved the sickness and vomiting. 

" Combining creasote with drugs which have a tendency to produce nausea, Dr. C. 
finds often answers very well, as many cases in the journals led him to expect. 
He has twice given it in combination with, in one case four, and in another six 
grains of sulphate of copper, as an astringent. In neither, was there sickness. 
Of course it is impossible to say with certainty, that this immunity from nausea 
was owing to the creasote. 

" When laid up v^'ith influenza about three years ago. Dr. C. was taking a mix- 
ture containing tartar emetic, which produced considerable nausea and vomiting, 
which induced him to embrace the opportunity of observing the effect of crea- 
sote in such circumstances. He took two or three drops, which speedily checked 
the retching. After resting about an hour, he resumed the mixture, which again 
produced its emetic effect, and this was again arrested by a similar dose. Fle 
afterwards took occasion to repeat this observation on two patients. Case. — 
The first was a young girl labouring under a bronchitic affection. He prescribed 
the tartar emetic solution in the morning, and returned some hours afterwards, 
when he found her very sick, and when he was beside her she vomited a little. 
She was directed to go on with the solution* every hour as formerly, and imme- 
diately after each dose to take two drops of creasote. In the course of the next 
two hours, she had taken a grain of tartar emetic and eight drops of creasote, 
without the nausea continuing or returning. As her face was flushed, and she 
complained a good deal of frontal headache, the creasote was discontinued. Un- 
fortunately the pulse was not counted before the experiment; but Dr. C.'s dis- 

* Each dose contained a quarter of a grain of the tartrate of antimony. 

194 Progress of the Medical Sciences, [Jan. 

tinct impression at the time was, that it was then stronger and fuller than after- 
Avards. Case. — In the other case, a grain of tartar emetic was dissolved in 
water, "and the patient, a stout young man, ordered to take a table-spoonful every 
half hour, till he vomited. After taking half of the mixture, violent vomiting 
and retching came on, when he took three drops of creasote. This only moder- 
ated the symptoms; after five minutes, three drops more were administered, 
which completely stopped the vomiting. The paucity of his observations. Dr. C. 
stated, did not entitle him to advance any suggestions as to the application of 
these cases to therapeutics; but he thought that they are at least sufficient to 
show, that creasote can control the operation of tartar emetic. As opportunities 
occur, he intends to prosecute this branch of the subject. 

*'In Neuralgia^ creasote has, in the opinion of many, been found useful; and 
from a knowledge of the sedative properties of the substance, along with some 
experience of it in this class of diseases, Dr. C. can easily believe that it may 
prove beneficial. The nine cases in which he has employed it, lose almost en- 
tirely their value as experimental provings of its curative powers of neuralgia, 
inasmuch as he had in them all purged the patient steadily, and sometimes very 
actively, with croton oil, generally employing the creasote simply as a palliative 
during the paroxysms, just as at other times we prescribe henbane, the muriate 
of morphia, and aconite. Here it is proper to speak guardedly; but from all 
Dr. C. has seen and read, he thinks it may turn out to be a good medicine to 
use under certain circumstances in neuralgia. Creasote plasters have of late been 
recommended in the journals; and a tar plaster is a favourite remedy for tic among 
sailors. The unquestionable relief from pain which creasote gives in toothache, 
is also a strong reason for making trial of it as an outward application in the dif- 
ferent forms of neuralgia. When an opportunity offers, he intends to try the 
effect of creasote plasters along the course of the affected nerves. 

" In Phthisis, some have maintained that creasote is quite a specific remedy, 
having the power of dissolving tubercle, and cicatrizing cavities in the lungs; 
but which of the drugs in our voluminous catalogue of materia medica have not 
in their turn been celebrated as all-potent in conquering what, we fear, must yet 
be called this invincible disease] 

"It has already been said, that creasote is useful in checking the vomiting of 
the latter stages of consumption; and when it is added, that its vapour some- 
times produces a soothing effect, and makes the expectoration more easy, all 
that can be truly advanced of its uses in this disease has been stated. The va- 
pour may be inhaled in the steam of hot water, placing the vessel under the 
mouth of the patient; or if this cannot be borne, the air of the apartment may 
easily be sufficiently saturated with the vapour, by allowing the steam of crea- 
sote water to escape for a certain time. 

"II. Creasote as an external application. — In toothache, creasote gene- 
rally gives immediate relief from pain, when properly applied to the exposed 
nerve, in the cavity of a carious tooth. Dr. C. has in his own person made re- 
peated trials of it, and is quite convinced, that though it gave respite from pain, 
it hastened the destruction of the teeth. This observation has been repeatedly 
made by others. 

" In arresting hemorrhage from small vessels, or the oozing of blood from 
abraded or cut surfaces, bleeding ulcers, and leech bites, a creasote ointment or 
lotion is very often effectual. It acts by coagulating albumen, and thus forming 
a crust. Pure creasote may be tried when the bleeding is more profuse. In the 
hospital at Cadiz Dr. C. saw it used with complete success, in the oozing of 
blood from the wound of a compound fracture. He never had an opportunity of 
seeing its power over pretty active hemorrhage, in the human subject, except in 
this case. 

" From experiments made on dogs and rabbits he is, however, quite satisfied 
that creasote possesses, in a high degree, the power of arresting hemorrhage 
from the capillaries; but in wounds, which it is desirable should unite by the 
first intention, its use should probably be abandoned as soon as the bleeding is 
fairly subdued, as, by uniting with the lymph effused, it forms a substance, 

1843.] Materia Medica and Pharmacy, 195 

which would act as injuriously to the progress of the reparative process, as any 
otheT foreign body, 

*'In chronic venereal ulcers^ Dr. C. has repeatedly used creasote with great ad- 
vantage. It answers very well to apply it pure once^ when there is great defi- 
ciency of action, and subsequently to employ an ointment of from four drops to 
thirty, to the ounce of lard. The lotion is also a very excellent form of appli- 
cation. In phagedenic ulcers^ ulcerated chilblains^ and sores yielding a sanious 
discharge. Dr. C. has often used creasote with great benefit. 

*' In the application of creasote to ulcers and other solutions of continuity, 
there are several facts which the practitioner should bear in mind. // is impor- 
tant to remember that water only dissolves one eightieth part. If an excess of crea- 
sote be present, it will float on the surface in small globules, and can therefore 
very easily be removed: but if this is not done, when the lint is dipped in the 
lotion, these globules will adhere, and in this way, a very difl^erent wash from 
what was intended, is placed upon the sore. In very few cases, where the raw 
surface is extensive, pure creasote ought to be applied to the whole of it, as se- 
vere irritation is generally the result. More or less inflammation, almost in 
every case, follows the application of the pure drug to a raw surface: it con- 
tinues, according to circumstances, from a few hours to several days, and there 
are instances in which a poultice is quite necessary. At the beginning of the 
treatment, creasote, either pure or in the form of lotion, should be more copiously 
applied than afterwards: and as soon as a healthy granulating surface appears it 
may with advantage be altogether discontinued, and some of the common lotions 
of the metallic salts substituted. When the ointment is applied to an irritable 
sore, it answers very well to put a poultice above it. To chancres, creasote 
ought to be applied with a camels' hair pencil. One or two applications are 
frequently sufficient, and more may do harm. 

*' In a case of condylomata Dr. C. found creasote useful: and in correcting the 
fetor of vaginal discharges he has also several times been assured by his patients 
that it proved successful, but as a remedy for the running it is very inferior to 
lotions of sulphate of copper, and sulphate of zinc, and the other common washes. 
He draws these conclusions partly from cases which he saw treated in the Lock 
Hospital of Edinburgh some years ago. 

*' In narrating the result of most of the trials which he had made with crea- 
sote, the author stated that he offered them, not as in themselves of much value, 
but merely as a contribution towards a proving of its real therapeutic value. In 
some other diseases in which he used it, it did no good, and in some evil; but 
as these were maladies to which he had not adverted, it was better to defer a 
statement regarding them. They were cases of diabetes, dyspepsia, rheuma- 
tism, irritable bladder, and cancer. Its effects in these cases, and in skin dis- 
eases, may, at a future time, be brought before the society." 

10. Manna. — "In the mountains above Tropoea, are large tracts of chesnuts, 
and the small leaved ash, the omas, which produces the manna. They do not 
plant it, but cut down the strong stems, and spring it from the old stocks. In 
July, they make a small gash, leaning upwards; the second day another, and 
form cups with maple leaves, into which the gum exudes. 

The tyranny exercised on the poor peasants in this article is very great. The 
manna is farmed out, and a certain number of countrymen are appointed to ga- 
ther it, during which time they are not at liberty to absent themselves, or under- 
take the most necessary labours for themselves. They scarcely derive any 
benefit from their work, as they are paid five carlini for a rotulo of manna (thirty- 
three ounces) which the farmers sell in Naples for nine carlini a pound (twelve 
ounces). If they burn or destroy the trees, though wild, their punishment is 
very severe, and if the smallest quantity is found in their houses, they are sent 
to prison. Eight hundred poor men, thus oppressed, contributed two carlini 
apiece, for a memorial to the king, but no notice was taken of it." — Swinburne'' s 
Courts of Europe at the end of the last century. T. R. B. 

196 Progress of the Medical Sciences. [J|in. 

11. Siidagogues, — Dr. Samuel Wright has published an elaborate and learned 
essay on the Fhysiology and Pathology of the Saliva^ in the London Lancet. 
Among- other matters, he enumerates incidentally, the various medicinal sub- 
stances, which, in addition to mercury and its compounds, have been known 
to induce salivation. Although the fact is well understood concerning most of 
them, yet it may be useful to enumerate the whole in consecutive order. 

1. Iodine and its salts sometimes act as remote sialagogues. Authorities 
Carro, quoted by Bayle; Dr. Manson, Cogswell's Essay on Iodine. 

Ilydriodate of potash has induced ptyalism, as observed by Drs. Clendenning 
and Wallace, and Dr. Wright himself. Cantu, Coindet and Gairdner have de- 
tected iodine by chemical tests, in the saliva of persons who are taking it. 

2. Chlorine. — The continued use of chlorine water is said to have caused sali- 
vation. Pereira. 

3. Bromine. — Dr. Glover produced ptyalism in dogs and rabbits by the admi- 
nistration of single poisonous doses of it. 

4. Digitalis. — A case is recorded in Rust's Magazine, in which the salivary 
discharge continued for three weeks. Other authorities. Withering, Christi- 
son. Barton. 

5. Hemlock. — The injection of a watery solution of hemlock into the veins of 
a horse has been known to produce salivation (Moirond). Dr. Wright has 
known a case in the human subject from the protracted use of hemlock. 

6. Belladonna sometimes affects the salivary glands. 

7. Arsenic. — Authorities. — Marcus, Ferriar, Furley, Trousseau and Pidoux; 
James Johnson. 

8. Opium., sometimes. Authorities., Christison, Paris, Watson. 

9. The Salts of Antimony., particularly tartar emetic and James' powder. Ma- 
gendie produced salivation in dogs by tartar emetic. So also Griffiths Jackson 
in the human subject. Dr. Wright has seen an active ptyalism, for a week, con- 
sequent on the use of James' powder. 

10. The Sa/ts of Zeaof occasionally. ^ 

11. Tdrc/i/omZe o/" Go/c/.— Chrestien, Niel. 

12. Frussic Acid. — Macleod, Granville. 

13. Nitric Acid. 

14. Nux Vomica. — In a case of poisoning by it, a profuse ptyalism has been 
observed. — London Medical Repository., Vol. 19. 

15. Caniharides. — Pereira mentions an instance of poisoning by it, in which 
ptyalism occurred. 

16. Sulphur used internally increases the salivary secretion. T. R. B. 

12. Pharmaceutical Bread. By Henry Deane. — Flour, 3 lbs. imperial; cold 
water, 1| pint imperial; sesquicarbonate of soda, ^ oz. (Troy weight); hydro- 
chloric acid, 5 fluid drachms; a small quantity of salt, if required. 

Mix the soda perfectly with the flour, and the acid with the water, then the 
whole intimately and speedily together, using a flat piece of wood or spaddle for 
that purpose, in preference to the hand. It may be made into two loaves, and 
put into a quick oven immediately. It will require about an hour and a half to 

Precautions. Let the soda be well mixed with the flour, for wherever a small 
lump of it is deposited unmixed, it is not perfectly acted upon by the acid, and 
causes a yellow spot in the loaf, which, however, is more unsightly than detri- 

The acid is the muriatic of commerce, and should have a specific gravity of 
1.16. It should be mixed with the whole of the water to be employed. 

The water should be as cold as possible. Three pounds of flour require about 
a pint and a half to make it into dough of proper consistence: but as the quality 
of flour varies according to season, and other circumstances, a little more or less 
water may be used, as occasion may require. 

The dough should not be made stiff". The thinner it is, so that it may be con- 
veniently handled, the lighter will be the bread. Much kneading is detrim.entaL 

1843.] Materia Medica and Pharmacy. 197 

The largest quantity of flour that can be convenientl}^ mixed at one time is 
about 12 lbs.; w here more is required, it is better accomplished by mixing it sepa- 

It requires a hotter oven and more time to bake than fermented bread does. 

The advantages to be derived from this process are important. In all climates 
and under all circumstances it may be adopted; and by it is entirely obviated all 
difficulty of procuring yeast or ferment, which is frequently of an inferior quality, 
vitiating the bread, and rendering it more or less unwholesome. 

The bread being free of all yeasty particles, is more digestible, and not so lia- 
ble to create flatulence, or turn acid on weak stomachs, as fermented bread is apt 
to do, even when of the finest quality. 

It is a great saving of time, trouble, and litter, and may be employed at all 
seasons of the year, without reference to temperature or atmospheric variations. 

Economically, yeast may possibly have the advantage when plentiful and 
good; but when scarce and bad, a common state of things during the summer 
months, particularly in remote districts, the saving of time, trouble, and risk, is 
invaluable. Where much bread is made for a family, as at some farm-houses, 
by purchasing the materials in large quantities, a considerable saving may be 
effected. — Pharmaceutical Trans. ^ No. 9. 

13. Phloridine. — This is a new medicine, which is now very highly spoken of 
by French practitioners as a useful adjunct to our cinchona preparations. If has 
been used for some years in Germany, Poland, and France. It is extracted from 
the bark of the roots of the apple-tree and the wild cherry-tree, and is thus pre- 
pared: the bark of recent roots is boiled with water sufficient to cover them, for 
half an hour. This is poured off, and the same quantity is again used; these 
two fluids are mixed together, and at the end of six hours deposit the phloridine 
in the form of a deep-red velvety-looking matter. 

M. Lebaudy, the editor of the Journal des Connaissances Medico- Chirur gicales^ 
says, " its efficacy is so decided, that we cannot hesitate to class it with the most 
powerful febrifuges; and it has this advantage over quinine, that it never induces 
gastralgia." — Braithwaite' s lietrospect. No. 5. 

14. Quininefound in the Urine and in the Blood. — On examining the sediment 
formed in the urine of a patient to whom quinine had been administered, on ac- 
count of periodical nervous pains, M. Landerer found, besides the phosphate 
and urate of lime, and carbonate of ammonia, a small quantity of quinine in a 
free state. The urine itself contained sulphate and hydrochlorate of ammonia, 
and also some traces of quinine. In two other patients to whom quinine had 
been administered for the cure of intermittent fevers, M. Landerer endeavoured 
to discover this alkaloid substance in the blood. One was bled for a pleurisy 
which supervened; the blood was inflammatory, and the coagulum covered with 
a thick buffy coat. When first drawn from "the vessel, and so long as it pre- 
served its heat, it had but a very slightly bitter taste; but after it had become 
cold, and the formation of the clot had taken place, the bitterness was very 
marked. A perceptible difference was discernible between the serum and the 
coagulated portion, the bitter taste being most marked in the former, and the 
quinine could be obtained from it by evaporation; then digesting the residue in 
acidulated water, filtering, and precipitating it by ammonia. In the second 
patient the analysis of the serum gave exactly similar results. London Med* 
Gaz. July 1842, from Repertorium fiir die Pharmacie. 

198 Progress of the Medical Sciences. [Jj 



15. Hypertrophy of the Brain in Children. — Mr. Cathcart Lees relates, in the 
Dublin Journal of Medical Science for September last, three cases of this occurring 
in his own practice, and presents some interesting remarks as to the diagnosis 
of that condition. 

We subjoin the cases with his general conclusions. 

"Case I. — John Harding, aged two years, a full, heavy-looking child, was 
admitted into the hospital in May, 1842, for pertussis; his mother states that he 
has always been healthy, but very heavy and drowsy^ not playful like her other 
children; his appetite has always been great. The head is rather larger than 
it ought to be in proportion to his age, particularly across the parietal protube- 
rances, which form considerable projections; the frontal bone also projects over 
the root of the nose; fontanelles perfectly ossified; his eyes are large, promi- 
nent, and widely set; the intelligence is perfect, but he appears to be very apa- 
thetic^ and does not mind any object attentively but his food, for which he is 
very greedy; he is easily made to cry; there was no fever on him, but the par- 
oxysms of the cough were very violent, and frequently succeeded by convulsions, 
which were general, and in one of which he died on the sixth day of his disease. 

" On removing the calvarium, the dura mater appeared to be tense, and on di- 
viding it, the cerebrum appeared swollen, and protruded through the membranes; 
the convolutions appeared to be flattened as if compressed; the vessels of the 
pia mater were injected with very red blood; the substance of the brain was 
much congested, but of a firm consistence and very large; there was no serous 
eflTusion into the ventricles; there was a slight vascularity of bronchial mucous 
membrane; the bronchial glands were not enlarged; the larynx was perfectly 
healthy; there were a very few dark, firm spots, like the dots in pulmonary 
apoplexy, scattered through the lungs, and quite isolated; all the nerves were 
carefully dissected, and presented nothing abnormal. 

" Case IT. — Ann Murphy, aged three, a very delicate looking child, with the 
head large in proportion to the body, which is emaciated, particularly the lower 
extremities; the abdomen is tumid; there is considerable projection of the frontal 
bone, as also of the posterior angles of both parietal bones; the eyes are heavy, 
and widely set, so as to give the child the face of one with chronic hydrocepha- 
lus; the fontanelles are quite closed and firm, but cartilaginous; she is very 
cross and greedy, crying whenever she sees food, till she gets it, when she falls 
asleep over it; in fact she spends her time in crying, eating, and sleeping. Her 
intellect is obtuse, but appears to be perfect; the pulse was generally regular, 
and her pupils natural. She had been left at the gate of the hospital, so we did 
not know her previous history, but she remained some months under my obser- 
vation previous to her death, which took place gradually from chronic diarrhoea, 
without convulsions. 

"The brain weighed two pounds three ounces; the dura mater was firmly adhe- 
rent to the cranium; the brain was large, the dura mater being rather tense over 
it; the substance of the brain was firmer than is natural in a child of that age, 
and also of a paler appearance; there was not any fluid in the ventricles nor at 
the base of the brain; in fact, it appeared to be nearly void of either blood or 
serum; there were not any tubercles in either the lungs or abdomen.* 

* " It is very difficult to ascertain with any degreeof accuracy, the average weight of 
the healthy brain at different periods of life, and still more, tlie weight of it in various 
diseases, as it must be always open to a source of flillacy, resulting from other causes, 
as the amount of congestion, fluid, and the results of disease; thus, Dr. Sims has given 
a table containing the weight of 253 brains in different diseases, and then states that 
the weight of the brain cannot be fixed by any means, however accurate, which is 
further proved by several cases given by him, in which the brain was found unusually 
large and heavy from various causes, but which did not constitute hypertrophy. 

1843.] Medical Pathology and Therapeutics, 199 

" Case III. — Mary L., aged seven, light brown hair, delicate skin, appears as 
if she is always dropping asleep; her pupils are natural; pulse regular; her 
functions are well performed; her temper is very bad; she will not learn her 
lessons, but this appears to depend more upon indolence than stupidity; her ap- 
petite is very great; her head is not too large in proportion to her body, but there 
is considerable projection across the parietal protuberances; she complains fre- 
quently of headache, and sometimes vomits in the morning. I was consulted 
on July 10, 1842, for a strumous swelling in the neck of this child, and was so 
struck by her appearance, that I inquired particularly into her history. 

" I have placed these cases in apposition, in order that we may compare them 
with regard to their early symptoms, as I think they are chiefly valuable from 
their accurate previous history, for in none of the cases which have been hitherto 
published, has there been any stress laid on this point, which, however, is of 
paramount importance. In the cases related by Andral, headache, convulsions, 
and epilepsy, appear to have occurred, but they only came under his observation 
in the second, or acute stage of this state, when the brain was suffering from 
compression, as in his cases the dimensions of the cranium were not larger than 
natural, which must cause a great difference in the symptoms. Thus idiocy, 
which depends so frequently on atrophy of the brain, may be caused by hyper- 
trophy, if there be much compression, whereas, if the cranium be developed in 
the same ratio with the brain, there are often no symptoms produced, or but 
slight ones, as in a case related by M. Scoutteten,* where a child of five years 
old was affected with hypertrophy of the brain (with enlargement of the skull) 
to such a degree, that the head became as large as that of an adult, particularly 
prominent at the occipital protuberances; the cerebral functions were undis- 
turbed, and the only phenomena which the child presented during life were the 
frequent fallings occasioned by the weight of the head, which was carried for- 
ward whenever the child wished to run, and a great tendency to sleep when he 
remained quiet. He died of acute enteritis, and the brain exhibited a great de- 
velopement of all its parts, with only a small quantity of reddish serum in the 

" Let us now classify the symptoms which the above cases presented, and see 
how far they may assist us in establishing a diagnosis. 

"First, with regard to intelligence. 

"There was a peculiar obluseness (f intellect, characterised chiefly by apathy to 
external objects, and a great tendency to drowsiness. There also was evinced a 
peculiar irritability of temper. 

" Andral states, that in adults, headache, with severe exacerbations, is a pro- 
minent symptom; this also occurred in the last case detailed by me. He also 
mentions weakness of the limbs, often ending in paralysis, convulsion, epilepsy; 
but these symptoms belong to the second period of this state, when it has passed 
into the acute stage; but as it is an essential feature of every hypertrophy to de- 
velope itself slowly, I have only had an opportunity of studying this state in the 
first or chronic period, as the two first children died of other diseases before they 
had reached the second period, which most probably would occur about the 
second dentition; thus in observation 4th of Andral, the boy became epileptic 
at the age of seven years, and died comatose, after a fit, at nine years old. 

" The appetite was very great in all the cases which I have noted, and there 
existed {\\e peculiar projection of the parietal protuberances, on which Dr. Munch- 
meyer particularly insists, and which, 1 think, may prove a valuable- guide in 
aiding to discriminate this state from chronic hydrocephalus, with which disease 
it is most frequently confounded. Thus, in the first case related by Dr. Sims, 
the mother of the child informed him that they had wished to tap the head at 
one of the hospitals. And Dr. Hennis Green, f in an excellent article on this 
subject, states that he recently had seen a child who had been condemned to 
death by a medical man, as having water on the brain, but which was a case of 

* Archives Generales, vol. vii. 

t Provincial Medical and Surgical Journal. 

200 Progress of the Medical Sciences. [Jan. 

simple hypertrophy, and which did not interfere with the health of the child. 
The diagnostic sign which he gives, is the sensation of firmness communicated 
to the finger, on pressure being made over the fontanelles, in cases of hypertro- 
phy, as contrasted with the fluctuating feel in cases of chronic hydrocephalus; 
but this could not apply in cases of very young children, or in extreme cases. 

"The prognosis in children is not necessarily unfavourable, for as it is rather 
an error of development than an actual disease, there is a natural tendency to 
return to the normal state; the chief danger, in fact, arising from the occurrencs 
of other diseases, as those attendant on dentition, the exanthemata." 

16. Empyema terminating; favourably by spontaneous opening. — Samuel Short- 
ridge, Esq. records in the Edinb. Medical and SurgicalJournal for October last, an 
exceedingly interesting case, illustrative of the marmer which nature often adopts 
for effecting a cure in cases of pleurisy terminating in empyema. 

The subject cf this case was a man of a stout, robust appearance, who pre- 
sented the usual symptoms of acute inflammatory fever, accompanied with cough, 
dyspncea, and a fixed pain near to the inferior border of the left scapula, extend- 
ing across the posterior surface of the chest. 

On the 3d of October, 1838, while engaged in raising a heavy piece of timber, 
*' he felt something give a crack" in the foregoing position, which, however, did 
not prevent him continuing his employment during the entire day; but on the 
following day, while rowing a boat, he became chilly and squeamish, and was 
forced to bed, when the above symptoms made their appearance. 

Mr. S. saw him on the 5th of October, and took blood to syncope, and pre- 
scribed an antimonial saline mixture, some powders containing calomel and anti- 
monial powder, and applied a sinapism to the painful part. 

On the following day, there being no improvement, the blood-letting was re- 
peated, a large blister was applied, and the medicine continued. The sputa, 
which now became more copious, from its rusty character, and the ordinary ste- 
thoscopic indications, enabled me to consider the inflammatory action to have ex- 
tended to the substance of the lung. The usual antiphlogistic measures were 
continued; blisters repeated from time to time; and in the course of a few days, 
the acute febrile symptoms subsided; but there still remained the fixed pain near 
the scapula, frequent cough, copious expectoration, and a total inability to lie 
upon the right side, any attempt at which greatly aggravated the cough and 
dyspnoea. Very little benefit was derived from the treatment adopted; colliqua- 
tive perspirations were superadded, to ameliorate which, mineral acid and qui- 
nine were had recourse to. 

Towards the end of December, debility and emaciation had advanced progress- 
ively, and a fulness was observed over the left side of the chest, although no 
difference in its capacity was found upon measurement; percussion on the part 
elicited a dull sound; and the respiratory murmur was very faint, although audi- 
ble over the subclavian region; and a few days after, a soft tumour appeared on 
the fifth intercostal space, an inch below, and to the outside of the left nipple. 

The next day Mr. vS. found that the surface of the tumour had ulcerated, and 
the patient lay bathed in purulent matter, the bed and clothes being fully satu- 
rated with it. The purulent matter continued to flow daily from the aperture, and 
and some came afterwards by the mouth. The patient was afterwards kept com- 
fortable by evacuating the purulent matter night and morning to the extent of a 
pint, which was facilitated by turning him to the left side, and requesting a full 
inspiration and a cough to be made, when a soft pledget with a quantity of tow 
and a bandage was applied. 

The cough and dyspncea were now greatly relieved; a generous diet, with por- 
ter, together with the acid and quinine, were prescribed, under which he gradu- 
ally regained so much strength as allowed him to go out of doors by March, 1839, 
and henceforward he continued still so weakly as only to be able to walk a very 
short distance, while the purulent matter was continued to be evacuated night and 
morning, in nearly the same quantities as at first, by removing the bandages, &c. 
until three weeks ago, when blood appeared instead of purulent matter, and the 

1843.] Medical Pathology and Therapeutics. 201 

wound thereafter closed, leavinor a flattened, thimble-like cavity, into which the 
point of the finger could be introduced; and he has since progressed in strength. 

Upon examination, the movements of both sides of the chest are equable, and 
the respiratory murmur natural, as also the sound elicited by percussion. 

The successful result of this case may, perhaps, be regarded as a support to 
the practice generally adopted, of gradually evacuating such collections, as it is 
very probable that only as much purulent matter flowed in the first instance as 
reduced it to the level of the aperture. 

17. Cirrhosis of the Lung. — Dr. Stokes exhibited to the Pathological Society 
of Dublin a specimen of that disease of the lung, first described by Dr. Corri- 
gan, under the title of cirrhosis of the lung. Its general characters are, a ten- 
dency to consolidation or contraction of the pulmonic tissue, with dilatation of 
the bronchial tubes. Dr. Stokes' patient had been labouring for months under 
cough, with dyspnoea and hectic fever, and died two days after her admission 
into the hospital. The physical signs were dulness of sound on percussion over 
the upper part of both lungs, but no decided or unequivocal signs of cavities. 
The appearance of the lungs on dissection was very characteristic; the left, 
which was the more diseased, was greatly diminished in size, and very irregular 
on its surface, so that when the hand was passed over it numerous small bodies 
could be felt, conveying to the fingers the impression of tubercles existing on 
the surface of the organ; this was produced by the presence of air vesicles. On 
making a longitudinal section of the trachea and primary divisions of the bronchi, 
the right bronchus, immediately after it branched off from the trachea, became 
greatly dilated, so as to exceed the latter in diameter, while the left bronchus 
was evidently contracted and reduced below its ordinary calibre, but dilated 
again a little further down. 

At a subsequent meeting, Dr. Greene exhibited another specimen of pulmo- 
nary cirrhosis, with dilated bronchial tubes, closely resembling phthisical cavi- 
ties, taken from a woman who had long suffered from intractable cough, and who 
was affected with a train of symptoms closely resembling phihisis. The physi- 
cal signs were, cavernous respiration and distinct pectoriloquy in the right infra- 
clavicular space; the latter sign was also found at the inferior angle of the 
scapula, and in the right axilla; distinct gargouillement, with bronchial respira- 
tion could be heard in various parts of the chest. The left lung presented the 
signs of bronchitis. The lung, on examination after .death, was found to be 
diminished in size and indurated; the cavities formed by the dilatation of the 
tubes were of considerable size, and did not contain purulent matter; they were 
largest near the surface of the lung, and towards its upper part. Their cartila- 
ginous structure could be distinctly traced. There was not any sign of tubercu- 
lar deposition in either lung. The pleura was greatly thickened, and the dia- 
phragm was adherent to the liver. 

LaBunec attributed this complaint to constant cough, and accumulation of 
mucus in the bronchial tubes. His opinion is, however, liable to objection, and 
his account of the causes to which the dilatation is owing is not sufficient to ex- 
plain all the phenomena. According to Dr. Corrigan, the primary seat of the 
disease is in the web of cellular tissue which constitutes the matrix of the 
lung, which has a tendency to contract, so as to produce, when the disease is 
advanced, a very considerable obliteration of the air-cells. He thinks the dimi- 
nution of the lung the first step in the disease, of which the dilatation of the 
bronchi is a consequence. — Frov. Med. Juurn. Aug. 13, 1842, from Dublin Medi- 
cal Journ. May 1842. 

1 8. Microscopical characters of the sputa in Phthisical Patients. — M. Sandras 
read before the Academy of Medicine of Paris, August 30lh, a memoir on this 
subject. He selected from the Hotel-Dieu, patienis in whom phthisis was well 
marked; after having collected their sputa in a small tube, he submitted them to 
a microscope of 300 diameters, and he believes that his experiments will con- 
firm the already existing opinion, that the expectoration of consumptive people 

202 Progress of the Medical Sciences. [Jan. 

is quite different from that given off by the lunofs in other diseases, and that they 
show further, that this mode of examination will materially assist the diagnosis 
of this disease, formed by the stethoscope. He found that the expectoration 
consisted of numerous round globules, separated from each other, of a greyish 
white colour, and similar in size and form to the globules of pus, but differing 
from them in this respect, that the latter are circumscribed, while the former are 
surrounded by a kind of rough layer, which it is impossible to remove by wash- 
ing. They are also opaque in the centre, and become gradually clearer as we 
approach their border. The above data were drawn from 49 patients; but he 
observes at the same time, that the sputa of all phthisical subjects do not present 
a similar appearance, — a circumstance which can be easily accounted for, when 
we consider that invalids are in general affected at the same time with bronchitis. 
M. Sandras was unable to discover the globules above described, in tuberculous 
abscesses in other parts of the body. On examining the expectoration from 
simple catarrh, it was found to be apparently similar in appearance, having small 
corpuscles, but no globules; these were not isolated from each other, were not all 
of a like size, disappeared or only appeared in an indistinct manner under the 
microscope, and their surface was frequently striated. Notwithstanding these 
striking differences, cases are occasionally met with, in which it is very difficult 
to decide whether the disease is phthisis or bronchitis. M. S. does not think 
that the pus comes from the tubercular matter itself, but from the secretion in 
the centre of which the tubercle is placed; nevertheless, the signs afforded by it 
are not of less importance in the diagnosis of the disease. — L. ^ E. Monthly J, 
Med. Sc. Oct. 1842. 

19. Treatment of the Hemorrhagic Diathesis. — The Londo7i and Edinburgh 
Monthly Journal of Medical Science for July last contains an exceedingly interest- 
ing paper on this subject, read before the Medico-Chirurgical Society of Edin- 
burgh, by James Miller, the successor of Sir Charles Bell, in the Surgical chair 
of the University of Edinburgh. 

To constitute the hemorrhagic diathesis, we have not only, Mr. Miller ob- 
serves, the blood flowing through dilated and non-contractile tubes, but 
sent thither in greater volume than in ordinary and healthy circumstances, 
thinner and more fluent than in health, and little if at all able to arrest its own 
course by assuming the solid form. In addition, the capillary tunics are not only 
thin, but weak, and easily lacerable; a slight bruise produces serious ecchymo- 
sis; coughing may induce haemoptysis; a sneeze brings on epistaxis; diarrhoea 
occasions copious evacuations of blood by the rectum; and extravasations are 
not unlikely to follow but slight causes within internal .cavities. The whole cir- 
culating system, besides, is usually in an irritable and excited condition; the 
pulse being considerably above the healthy standard, and the heart acting with 
unusual force and sharpness. Not unfrequently, a febrile condition at the same 
time exists; and when it does exist, it increases the intensity of the diathesis. 

In the treatment of the hemorrhagic diathesis, Mr. M. directs attention to the 
following points: — 1. Energetic treatment at the outset, for then only have we the 
blood favourable for coagulation, and the parts tolerant of pressure. 2. Thepru- 
priety of internal remedies — astringents, sedatives, nauseants, and hydragogues — 
to obviate, if possible, the morbid condition of the blood; and administered 
either by the mouth or anus, according to circumstances. 3. Abandonment of 
escharotics — especially of the actual cautery, being at the best only occasionally 
and temporarily beneficial, and ultimately highly pernicious. 4. Pressure, pre- 
ceded by a styptic, early, accurately, uniformly, and yet moderately applied, the 
best local means of treatment. 5. Irritants and cupping, at some distance from 
the bleeding point, not unlikely to prove beneficial; the former by creating an 
inflammation in a comparatively unimportant part, and thereby increasing the 
amount of fibrin in the general mass of blood; the latter by averting the sangui- 
neous determination to the source of hemorrhage. 6. Careful avoidance of sim- 
ply febrile accession, which would have the effect of exciting the circulation, at the 
same time diminishing still further the amount of fibrin. 7. Patient persistence 

1843.] Medical Pathology and Therapeutics, 203 

in the foregoing system, without abrupt or frequent change of remedies. 8. In 
protracted cases, nutritious^ yet non-stimulant diet. 9. Failing ordinary means, 
transfusion is to be attempted. 10. The question o^ prophylaxis^ not irrational; 
the tendency being once known, its removal ought at least to be attempted. 

20. Very simple mode of arresting Epistaxis. — M. Negrier, of Angers, states 
that the following simple plan almost invariably succeeds in arresting bleeding 
from the nose: — The child is made to stand erect, with the head elevated. The 
nostril from which the blood flows is compressed by means of the fingers, and 
the corresponding arm is directed to be raised perpendicularly, and be retained in 
that position for about two minutes. The hemorrhage in general was arrested 
in ten seconds from the moment of raising the arm. Dr. Negrier has met with 
eleven cases of epistaxis, five of which he details, which were cured by this sim- 
ple means; and he states, that, whether the hemorrhagy was due to a general 
plethora, or to a temporary congestion of blood in the head, the sudden elevation 
of the arm corresponding to the nostril from which the blood flowed almost al- 
ways suspended the bleeding. Two or three times only he has seen the epis- 
taxis return; but it always ceased on the elevation of the arm. It never, how- 
ever, returned if the person had lost six to nine ounces of blood before the treat- 
ment was had recourse to. 

One case is related where a bleeding, resulting from a slight incision of the 
skin of the upper lip, was arrested by the same simple means. This case 
was the more remarkable, as the bleeding would not stop, though the wound was 
covered by court-plaster, and freely cauterized with the solid nitrate of silver. 
On raising the two arms perpendicularly, the bleeding was arrested on the instant, 
but restored as soon as they were lowered; but on maintaining them in the per- 
pendicular position for about a couple of minutes, the bleeding was definitively 
arrested. — Ed, Med. and Surg. Journ., October, 1842, from Archives Generales^ 
June, 1842. 

21. Prevention of sore nipples. — Mr. Marcus recommends as a means of pre- 
venting sore nipples, washing these parts and also a great portion of the mamma, 
three times a day, commencing from the sixth month of pregnancy, with tar 
water. — Journ, des Connais. Med. Prat., Feb. 1842. 

22. Deafness curedhy the endermic use of Morphia. — Dr. Hoebeke relates in the 
Archives de Med. Beige, the following case of deafness, the cure of which ho 
ascribes to the endermic use of morphia. A lady had become so deaf after an 
attack of fever that she could not distinguish a word, unless it was bawled into 
her ear by applying the mouth close to it. But along with the deafness there 
was always an incessant noise in the ears — at one time like the hissing of boil- 
ing water, at other times like the roaring of a hundred voices together — which 
was often so distressing as to cause headache and confusion of ideas: — these 
feelings were always worse when the head was on the pillow. There was a 
quantity of wax in the ears; but no relief was obtained when it was removed. 
Nothing irregular could be perceived either in the ears themselves or in the 
throat. Leeches were applied behind the ears, and emetics and purgatives 
given; but no relief followed. Supposing that the symptoms might be depend- 
ent upon some anomalous state of the nervous apparatus, a blister was applied 
behind each ear, and the excoriated surface was sprinkled with half a grain of 
sulphate of morphia. By the next day the noise and deafness on the left side 
had quite ceased, and on the right were much abated: — the headache, too, had 

As the unpleasant feelings still continued on the right side, a second blister 
was applied and treated in the same manner as before, with morphia: — the suc- 
cess was decided, and the patient was quite freed of all his annoyances. 

[^ We opine the blistering had quite as much to do with the cure as the morphia.] 

23. Typhus Fever in an Old Woman, — M. Rayer exhibited to the Academy of 

204 Progress of the Medical Sciences. [Jan. 

Medicine of Paris, August 30, a preparation of the morbid degeneration to which 
the glands of the small intestines are subject in typhus fever, as it occurs in Paris; 
and he prefaced the remarks on his case by saying, that some years ago, M. 
Chomel had declared, that he was not aware of a single authentic case of typhus 
fever having been met with in a person above the age of fifty-five. Since that 
period, M. Prus had reported an instance of a person seventy-four years of age, 
who was affected with that disease; and the individual from whom he obtained 
the specimens at present on the table, was fifty years of age when attacked. — 
Lond. ^ Ed, Month. Journ., Oct. 1842. 

24. Aphthae of the Neck of the Uterus. — M. Coute asserts, in a memoir read to 
the Academy of Sciences, 19th Sept. last, that aphthas of the neck of the uterus, 
though not described by writers, is a very frequent affection. 

25. On Percussion. — By John Hughes Bennett. Mediate percussion as em- 
ployed by M. Piorry, is undoubtedly a more valuable means of diagnosis than 
is generally allowed. His experience, it is said, enables him to "map out, as 
it were, on the surface of the skin, with ink, the size and form of the heart, arch 
of the aorta, liver, spleen, kidney, &c.; and indicate to the eighth of an inch, the 
exact height of pleuritic effusion, or the margin of circumscribed pneumonic 
dulness." At first sight this partakes too much of the marvellous, but when we 
know the length of time he takes to percuss a single patient, (half an hour,) 
we may suppose him to be a more expert operator than the generality of prac- 
titioners. The instruments he uses are, 1st. The Hammer: the head of which 
is made of steel, brass, or iron; a capsule is screwed to the end with a projecting 
disc of caoutchouc; the handle is made of wood, with depressions for the fingers 
and thumb. The head of the handle is not placed exactly at right angles with 
the handle, but has a slight obliquity upwards. "-This is necessary, because 
in employing it the handle is almost certain to be somewhat elevated, and this 
slight obliquity even then allows the practitioner to strike the pleximeter per- 
pendicularly." 2d. The Pleximeter: made of ivory, wood, or metal, with a 
handle at each extremity, to enable the practitioner to take hold of it more 

General rules to be followed in the practice of Mediate Percussion. — 1 . The plexi- 
meter should be held by the projecting handles between the thumb and index 
finger of the left hand, and pressed firmly down upon the organ to be percussed. 
Much depends upon this rule being followed, as the sound and sense of resist- 
ence are considerably modified according to the pressure made by the plexime- 
ter. A very easy experiment will prove this. If, for instance, the pleximeter 
be struck while it rests lightly on the abdomen over the umbilicus, and again, 
when it is pressed firmly down amongst the viscera, the change in tone will be 
at once perceived. In the first case a sound is produced, from the muscles and 
integuments being alone influenced by the force of the blow; in the second case, 
a clear tympanitic sound is occasioned from the vibration of the walls of the 
intestine. In every instance, therefore, the pleximeter should be so held and 
presssed down, as to render it, so to speak, a part of the organ we wish to 

2. Care must be taken to strike the pleximeter fairly and perpendicularly. 
Unless this be done, vibrations are communicated to textures in the neighbour- 
hood of the organ to be percussed, and fallacious results are the consequence. 
If, in percussing the lungs, for example, the blow be made obliquely, we obtain 
the dull sound produced by the rib, and 1 have seen considerable error in the 
diagnosis thus occasioned. 

3. A strong or gentle stroke with the hammer will modify the tone and sense 
of resistance, inasmuch as the impulse may be communicated by one or the 
other to a deep-seated or a superficial organ. Thus a gentle stroke will elicit a 
pulmonal tympanitic sound just below the fourth rib, where a thin layer of lung 
covers the liver, but a strong one will cause a jecoral parenchymatous sound. At 
the inferior margin of the liver, on the other hand, where a thin layer of the 

1843.] Medical Pathology and Therapeutics, 205 

orcran covers the intestines, the reverse of this takes place, a gentle stroke occa- 
sioninor a dull, and a strong one a clear sound. 

4. By withdrawing the hammer immediately after the blow, we are better 
able to judge of the sound; by allowing it to remain a moment, we can judge 
better of the sense of resistance. 

5. The integuments should not be stretched over the part percussed, as when 
the stethoscope is employed, for an unnatural degree of resistance is thus com- 
municated to the hand of the operator from the muscular tension. In every case, 
especially where the abdomen is examined, the integuments and superficial 
muscles should be rendered as flaccid as possible. 

6. It is always best to percuss on the naked skin. It is not absolutely essen- 
tial, however, and in cases where, from motives of delicacy, it is desirable that 
the chest or abdomen be not exposed, it only becomes necessary that the 
covering of linen or flannel be of equal thickness throughout, and not thrown 
into folds. 

Special rules to be followed in percussing the cAes^.— Percussion of the lungs 
generally bears reference to a change in density, which is only to be detected by 
comparing the healthy with the morbid portions. The great practical rule here 
to be followed, is to apply the pleximeter to both sides of the chest in succeS' 
sion, with the same firmness, exactly in the same situation, and let the 
blow with the hammer be given with the same force. Care must be taken 
that the position of both arms be alike, as the contraction of the pectoral 
muscles on one side more than on the other may induce error. In short, every 
circumstance must he the same before it is possible to determine in delicate 
cases, either from the tone or sense of resistance, whether change of density 
exist in the lungs. When circumscribed alterations are discovered in the pul- 
monary tissue, their limits may be marked out on the surface of the skin, in 
the manner previously indicated. In this way, I have frequently succeeded in 
determining with accuracy the size and form of circumscribed indurations, 
arising from partial pneumonia and pulmonary apoplexy. Under the clavicles, 
the pleximeter must be applied with great firmness. Inferiorly, a thin layer of 
lung lies over the superior surface of the liver; and to determine the exact place 
where its inferior border terminates, the blows with the hammer should be very 
slight. Posteriorly, also, the pleximeter must be firmly applied, and the force 
of the blows considerable: but they should decrease in force inferiorly, where a 
thin layer of lung descends over the liver much deeper than anteriorly. 

In a healthy state, a distinct difference may be observed in the sonoriety of the 
lungs immediately after a full expiration and a full inspiration. This does not 
take place when the tissue becomes indurated from any cause; and thus we are 
furnished with a valuable diagnostic sign. Congestion of the lung, and pneu- 
monia in its first stage, causes only slight dulness and increased resistance, 
which, however, are readily detected by the practised percussor. In the second 
and third stage of pneumonia, and in apoplexy of the lung, this dulness and re- 
sistance are well marked, and even an impression of hardness and solidity com- 
municated to the hand. When, however, the lung is studded with tubercles, 
the induration is most intense, and the greatest degree of resistance commu- 

Partial induration from pneumonia, apoplexy, or tubercular deposition, may 
be detected by percussion, even when deep-seated and covered by healthy por- 
tions of the lungs. In this case, by pressing with the pleximeter, and striking 
lightly, a tympanitic sound is only heard; but by pressing the pleximeter down 
firmly, and striking with force, the dull sound may be elicited and circum- 
scribed. When induration, however, exists inferiorly in those portions of the, 
lungs which overlap the liver, it requires great practice to detect them with cer- 
tainty. Caverns in the lungs, when large and filled with air, induce a tympa- 
nitic sound; but they are generally more or less full of viscous and fluid matters, 
and give rise to dulness. 

Two or three ounces of fluid may be detected in the pleural cavity, by causing 
the patient to sit up. It is readily distinguished posteriorly, from the dulness 
No. IX.-— January, 1842. 14 

206 Progress of the Medical Sciences, [Jan. 

of the liver on the right side; on the left, however, the limit between it and the 
spleen is not so well marked. The height or level of the fluid is readily deter- 
mined, and should be marked daily by a line made with nitrate of silver. If the 
effusion be only on one side, the peculiar humoral dulness is more easily de- 
tected. It disappears on placing the patient in such a position as will cause the 
fluid to accumulate in another part of the pleural cavity, when the space, which 
was previously dull, becomes clear. When the effusion entirely fills the pleural 
cavity, no limit of course can by detected; but, even then, the dulness is dis- 
tinguished from that of the liver by the diminished feeling of resistance. 

When air is effused into the pleura, the sound is like that of a drum, and 
readily detected. — BraithwaiWs Retrospect from Lvnd, ^ Edin. Monthly Juurn, 
of Med. Set. Feb. 1842. 


26. Injury to the Elbow-joint in Children. — Mr. Sylvester communicated to 
the Reading Pathological Society a brief sketch of four cases of injury to the 
elbow-joint, occurring in children generally under four years of age, of relaxed 
and strumous habits, resulting, he thought, from partial dislocation of the radius, 
and caused by lifting the child by the wrists, or catching it by the arms when 
falling. The displacement was easily reduced, and as easily recurred. — Dr. 
Cowan's Retrospective Address in Prov. Med. Journ., 13 Aug. 1842. 

Sprains and partial dislocation of the shoulder and elbow-joints from careless 
handling of children are not of very rare occurrence. We have seen several ex- 
amples of these accidents. Fractures of the forearm occur from the same causes. 
We were called to a child some years since, whose radius was fractured by her 
mother in helping her over a gutter. 

27. Operation for enlarged Patellar Bursa. — Dr. Hargrave of Dublin, per- 
formed the following operation on a healthy housemaid, 21 years of age, admit- 
ted into the city of Dublin Hospital, with enlarged patellar bursa. 

June 8th, 1841. — "An incision to the extent of one-eighth of an inch, was made 
along the outer margin of the tumour; then a very small bistoury was introduced 
obliquely into the cyst, at such a distance from the superficial cutaneous incision 
as prevented the escape of the fluid. 

"The sac was then cut in several places, chiefly on the anterior surface, and 
the instrument withdrawn, all the fluid having been evacuated. 

"A small compress was then applied, and several straps of adhesive plaster, 
and a roller which extended from the toes to the knee. 

"A splint was also applied, which extended from the middle of the back part 
of the thigh to the same point of the leg. 

" 10th. Dressings were removed; considerable diminution in size of swelling. 

" Straps of adhesive plaster were again applied nearly in the same way as that 
recommended by Baynton. — No constitutional disturbance. 

" 14th. Straps quite loose. A strong evidence of subsidence of swelling. 

" 17th. Natural appearance of the joint nearly restored. 

*' Discharged at her own request, but strictly cautioned against returning to 
her usual employment for some time. 

"If the incision, or rather puncture into the sac," Dr. Hargrave says, "be 
made with care, the internal surface of the cyst then cautiously scored after it, 
the fluid evacuated by firm pressure, so as to prevent the ingress of air into the 
cavity, no danger need be apprehended of unpleasant effects succeeding to this 
measure." "The only instances," he adds, "in which the subcutaneous inci- 
sion might fail, are those where the sac is much thickened, its interior loculated, 
and the cells filled with a thick gelatiniform substance: still in such instances, 
it is a means which should be kept in view." — Dublin Med. Press, Oct. 2G, 1842. 

1843.] Surgery, 207 

28. New Remedy for Scalds and Burns. — Mr. Wm. Rhind recommends as a 
remedy for burns and scalds, a solution of gum arable, repeated coats of it being 
applied, so as to form a complete covering to the injured parts. He relates seve- 
ral cases in which he tried it, and states that in all relief was procured in a very 
short time. The more recent the case, however, the more speedy was the re- 
moval of the pain. In those cases where blisters had appeared they were opened, 
and the solution applied; very frequently the application of the solution pre- 
vented the effusion of more serum; in some cases, however, serum was again 
effused and again evacuated. 

In those distressing cases of the extensive burning of the bodies of young 
children, Mr. R. states that he would not hesitate applying the solution over the 
whole body, at about the warmth of 96°. It does not cool down the system (he 
remarks) by sudden evaporation or sudden abstraction of heat, like a common cold 
fluid, a circumstance in most cases to be dreaded, for gum is a bad conductor of 
heat; neither does it preclude an exposure to moderately cool air, which seems to 
keep down the excessive irritation consequent upon extensive scalding of the skin. 

As it is of consequence to have the solution prepared instantly, the powdered 
gum, if it can be procured, may be in a few minutes dissolved in warm water. 
If this is not ready prepared, the common gum in small particles roughly pound- 
ed, will very soon dissolve, and the application in any case may be applied at a 
temperature of 96° or 100°, although in general it is more soothing when ap- 
plied colder. Rancid gum solution should not be used, as it in this state has 
lost its adhesive quality. Two, three, or four applications may be necessary at 
intervals of five or ten minutes. The skin should be previously freed of all 
oily matters, and the first coating, in order that it may be insinuated closely into 
the furrowed surfaces of the skin, should be rather thinner than the subsequent 
ones. In order to produce the proper effect it should form a varnished coat of 
some thickness and closeness over the whole space of the burnt part. — Edin- 
burgh Med. and Surg. Journ. Oct. 1842. 

29. Luxation of the Femur in a Child three years of age. — An interesting ex- 
ample of this is recorded by Mr. J. Kirby, in the Dublin Med. Press. Oct. 26, 
1842. The accident occurred in the following manner: — "The child was in the 
lap of a servant who was sitting on an outside jaunting car; alarmed at the fall- 
ing of the horse, she threw herself off, and pulled her charge with violence to 
the ground. He struck upon the external condyle of the left knee, where both 
abrasion of the skin and some contusion were perceptible. When taken up, it 
was observed that he was quite lame, but there was no complaint of pain in the 
affected articulation. Next day he was visited by the family physician. Doctor 
Robert O'Brien, who, finding no evidence of fracture, attributed the awkward 
position of the limb to restraint, produced by contusion, and he directed his 
treatment in accordance with that opinion. The following day he was attracted 
by increased deformity, and now he began to suspect articular injury, the cha- 
racter of which indicated the presence of luxation, while the years of the patient 
cautioned him neither to express such an opinion, nor to act upon it without 
having the advantage of further advice. Under these circumstances my assist- 
ance was required on the third day. I found the boy in bed, leaning to the affect- 
ed side, free I'rom pain, and quite playful, with a shortened limb, inverted knee 
and foot, and swollen buttock. He was removed to a table, and placed in a 
standing attitude, without exhibiting any evidence of suffering. The hip and 
gluteal region strongly resembled the advanced stage of morbus coxfe when the 
extremity becomes shortened and abscess exists around the joint, so considera- 
able and uniform was the convexity. The femur was somewhat* inclined for- 
ward by which the groin seemed sharply indented. The knee lay upon the 
other in a plane above the patella, while the extended foot, much inverted, rested 
on the inner front of the leg above the internal maleolus. The leg was slightly 
bent. The limb was shortened about two inches and a half. The cast of the 
spinal column was towards the distorted member. 

"To favour a more critical examination, the child was laid on his back, the 

208 Progress of the Medical Sciences. [Jan. 

shoulders being squared by his father, while Dr. O'Brien disposed the pelvis, so 
as to correspond with their direction. To ascertain how far elongation could be 
accomplished, I grasped the ancles with my left hand, my r'v^\\X finger being 
placed on the hip to observe trochanteric changes. During a gentle act of exten- 
sion, in which I turned the foot directly forward, ray fingers maintaining a scru- 
tinizing pressure on the hip-joint, where a solid fulness existed, I felt an obscure 
rubbing motion, which terminated in a sudden snap distinctly sensible to the 
bystanders. The extremity was instantly restored to its natural length and 
forui. The inguinal fold and glutcRal prominency at the same time disappeared, 
nor did they return when every opposition was removed." 

Three months had elapsed when the report was written, and the articulation 
was free from the consequences which might be supposed to ensue from such a 
serious violence. 

"■ Those who reason," Mr. K. observes, "from the anatomical structure of the 
hip-joint at so early a period, may be disposed to deny the possibility of dislo- 
cation, and may surmise that the reputed accident was one of separated epiphy- 
sis, or of fracture of the femur in a high situation. But the discordance of 
symptoms, with either supposition, taken together with the friction, snapping 
sound, immediate restoration to natural position and form, with the consequent 
rapid recovery, must strongly oppose the entertainment of such an opinion. 

"As liability to such displacement must henceforward be allowed, it may be 
questioned whether it be not one of no uncommon occurrence, and whether some 
of the celebrity of certain empirical bone-setters may not be attributable to their 
address in the management of an accident which regular practitioners are not 
prepared to encounter by pre-conceived notions of articular non-liability to such 
a luxation." 

30. Excision of Joints. — M. Roux thinks that he owes a considt^rable portion 
of the success which he has met with in performing this operation, to an im- 
portant modification adopted by bin), since August 1840, namely, in making a 
T incision by the side of the limb, instead of the H incision usually employed 
by other surgeons.* This modification renders it more easy to dress the wound 
without disturbing the limb, or causing it the slightest motion. The elbow is 
the joint to which this operation is most applicable. The following is the report 
of six cases of excision of this joint, performed by M. Roux. 

No. 1. — Caries of all the bones of the left elbow, in a woman aged 41. Com- 
plete success. Re-establishment of all the motions. 

No. 2. — White swelling of the right wrist, with abscess, numerous fistulous 
sinuses. Young man, aged 22. Excision of all the bones entering into the 
composition of the joint. Very remarkable success. 

No. 3 Excision of left elbow, in a man aged 59, for white swelling, accom- 
panied by abscess, sinuses, enormous fungous growths; success. 

No. 4. — Excision of the right humero-cubital articulation, for caries of the 
three bones. Death 16 days after the operation, from extensive erysipelas. 

No. 5. White swelling of the left elbow; excision; complete success, in a man 
aged 26. 

No. 6.— Exc'sion of the right elbow in a man, aged 40, for white swelling. 
The patient is still in the Hotel Dieu, the wound being not yet quite healed. — 
Med, Chirurg. Rev. Oct. 1842, from Gaz. Med. de Paris. 

31. Excision of the Elbow-joint. — M. Robert presented a woman, aged 26 
years, on whom he had practised the operation of excision of the elbow-joint. 
The disease rendering the operation necessary, was caries of the humero-cubital 
articulation, following a fall on the elbow. There were several fistulous open- 
ino-s about the olecranon. In the fold of the arm were two deep sinuses pene- 
trating into the joint. The soft parts around were moderately engorged. The 

* See No. of this Journal for July, 1841, p. 201, for particulars of this mode of ope- 

1843.] Surgery, 209 

operation was effected by dividing and reflecting the integuments over the olecra- 
non. The humerus was sawn through iraediately above the condyles, the ulna 
below the coronary process, and the radius just below its articular extremity. 
The limb was placed in the apparatus of M. Guizot. But little reaction ensued, 
and the fever and sleeplessness which had previously harassed the patient ceased 
immediately. Nevertheless, the suppuration continued a long time, it being im- 
possible to approximate the divided ends of the bones, and the wound was not 
completely cicatrised for 18 months. At the time of observation, two years and 
three months after the operation, it was interesting to observe the manner in which 
the movements of the fore-arm was executed. 

The limb had regained nearly the same size as that of the opposite side. When 
it was in repose, and hanging by the side of the thorax, there was perceived be- 
tween the extremity of the humerus and the bones of the fore-arm, a separation 
of nearly three fingers' breadth, occupied by a dense, but very flexible tissue, 
which allowed the fore-arm to move freely in all directions. The limb in this 
position looked as if impotent or paralyzed. But when the patient attempted to 
bend the fore-arm, the space comprised between the bones of the arm and fore- 
arm was effaced by the ascent of the latter, which mounted to obtain a fulcrum 
from the lower surface of the humerus, and the^movement of flexion was then 
effected, being carried to such an extent that the fore-arm formed a right angle 
with the arm. The patient could easily carry the hand to the head, or to the op- 
posite shoulder, and could raise tolerably heavy weights, as a chair. The power 
of pronating the hand existed in a moderate degree. The movements of the fin- 
gers were perfectly free. She could grasp, with tolerable force, bodies placed in 
her hand, and could hold objects of very small size. For several months she 
had resumed her occupation as a sempstress; she is accustomed to use her needle 
with the left hand, holding and fixing the work with the right. To avoid the 
fatigue which would result from long-continued flexion of the fore-arm, she wears, 
while at work, a small apparatus composed of two pieces of leather, one em- 
bracing the upper, the other the fore-arm, which are joined at the fold of the 
limb. — Seances de PJlcademie des Sciences, 

32. External Aneurism of the Internal Carotid Artery — Ligature of the artery — 
fatal. By James Svme, Professor of Clinical Surgery in the University of Edin- 
burgh. — In the beginning of last April I was requested by Sir William Newbig- 
ging to meet him and Dr. Abercrombie in consultation, on the case of a lady about 
60 years of age. She was rather tall and very thin, with the general appearance 
of feebleness inadequate for any sustained exertion. Her complaint was a tu- 
mour of the throat, in the situation of abscess connected with the tonsil. It was 
first noticed in the month of November preceding, after more than usual suffering 
from a dry, hard cough, which had existed with little interruption for five or six 
years. The swelling, at first very small, gradually increased, and at length oc- 
cupied the fauces so as to interfere with deglutition, and occasion uneasy feelings 
of distension by its bulk, which fully equalled that of a large walnut. It was 
not circumscribed in appearance, presenting, indeed, the diffused aspect of a pu- 
rulent collection, but when examined by the finger, was felt more distinctly 
limited than an abscess of the part. At the same time, its contents were found 
to fluctuate throughout their whole extent, and a strong, uniformly distending 
pulsation could be perceived over every part of the tumour accessible to touch. 
There could be no doubt as to the nature of the case, and as little in regard to 
the prognosis of its result, if effectual means were not taken to arrest the pro- 
gress of the disease. It was plain that an aneurism had formed in the course 
of the internal carotid artery, between its origin from the common trunk, and en- 
trance into the cranium. And it was no less obvious, considering the progressive 
enlargement that had already occurred, tocjether with the continued excitement 
from coughing, that the swelling, if permitted to increase, must soon encroach 
on the pharynx, so as to impede deglutition altogether, or cause suffocation, un- 
less the sac should ulcerate and relieve the patient by hemorrhage at an earlier 
period of her sufferings. We therefore decided upon recommending that the 

210 Progress of the Medical Sciences. [Jan. 

common carotid should be tied, and, meeting with no objection on the part of the 
lady or her friends, agreed to perform the operation on the following day. 

In presence of the gentlemen above mentioned, together with Drs. Patrick 
Newbiggingand Mackenzie, I cut down upon the vessel, and tied it with a single 
silk ligature, just below the crossing of the omo-hyoideus; no difficulty whatever 
was experienced in effecting this; hardly a tea-spoonful of blood escaped, and 
the patient walked to an adjoining bed-room without appearing to suffer or to 
have suffered almost any disturbance. During the day she complained of pain 
in the back of her neck near the occipital region, and struck me as looking even 
more pale than she had done previously; the pulsation of the tumour still con- 
tinued, but was much less forcible. In the evening a draught containing gr. xxx 
of the solution of muriate of morphia was prescribed in the event of restlessness, 
but not proving requisite, was withheld. 

Next morning, about six o'clock, 1 was informed that the patient had all at 
once been seized with nearly incessant vomiting and discharge from the bowels. 
On visiting her, I found all the signs of approaching dissolution, the weakness 
being extreme, the features bloodless, sunk, and altered in expression, and the 
pulse small, feeble, and irregular. The evacuation of greenish watery fluid, 
both upwards and downwards, still continued, though not so frequent as at first. 
Notwithstanding the use of stimulants, no improvement took place, and she ex- 
pired about six o'clock in the evening, thirty hours after the operation. 

The parts concerned were examined in presence of the gentlemen who had 
witnessed the operation, with the exception of Dr. Abercrombie, who was other- 
wise engaged, and with the addition of Mr. Goodsir, who assisted me on the 
occasion, and afterwards dissected the preparation. The artery was found to be 
tied just as could have been desired, without any disturbance of the vein, nerves, 
or neighbouring textures. It was traced upwards to the bifurcation, immediately 
beyond which the internal carotid dilated into an aneurismal sac. We then 
opened the head, to ascertain if the disease extended within the cranium, but dis- 
covered nothing in the state of the vessels at all abnormal. The lower jaw was 
next divided, so as to afford free access to the tumour, which, being exposed up 
to the base of the skull, allowed us to see that the artery, before entering the 
carotid canal, regained its usual characters. I cut it across there, and detached 
the whole extent of the vessel down to the root of the neck. 

It appears that a crevice, nearly half an inch in length, had been formed 
*^ through the inner coats in the upper or anterior surface of the internal carotid, 
about midway between its origin from the common trunk and entrance into the 
cranium; that the external coat had expanded so as to form the sac of the aneu- 
rism, and that the pressure caused by the tumour, which was considerably greater 
than would seem from the preparation after maceration in spirits, had distorted 
the course of the vessel, and given it a sigmoid direction. The contents of the 
sac were coagulated, except at a narrow channel corresponding with the current 
through the artery, which, it may hence be inferred, had not been completely 
arrested. Indeed, this was not and could not reasonably be expected, when the 
free retrograde passage afforded by the anastomosing communications of the ex- 
ternal carotid was taken into account. 

The result of this case was not less unexpected than distressing. I had fre- 
quently tied the carotid for aneurism and hemorrhage, and never met with the 
slightest bad consequence from the operation. The patient, though thin and fra- 
gile-looking, seemed free from any organic disease besides the aneurism, and 
possessed in a remarkable degree that composed disposition of mind which is so 
favourable to recovery from injuries. The artery was tied with more than usual 
facility, and with the most perfect insulation that could be desired. Though 
doubts might be entertained as to the cure of the disease, through want of suffi- 
cient obstruction in the flow of blood, no apprehension was entertained of dan- 
ger from the operation, and I feel quite unable to offer any satisfactory explana- 
tion of its fatal issue. 

In a pathological view Ihe case is interesting, from presenting an example of 
aneurism in a very unusual situation. The branches of the carotid artery within 

1843.] Surgery. 211 

the cranium occasionally expand into aneurismal sacs, which are apt, by their 
bursting-, to cause sudden death from hemorrhage. But aneurism of the internal 
carotid artery, exterior to the cranium, does not seem to have been hitherto ascer- 
tained and recorded. — Lond. and Edinb. Monthly Journ, Med. Sci.^ Nov, 1842. 

33. Sudden development of Subcutaneous Tumours. — The following very curious 
case of sudden development of subcutaneous tumours, in connection with dis- 
eased state of the stomach, was communicated to the Surgical Society of Ireland 
by Mr. Rumley. 

"A gentleman, astat. 44, sallow complexion, and dark hair, strong, healthy, and 
accustomed to active exercise in the open air, was prevented, by peculiar circum- 
stances, from taking his usual exercise, and in order to beguile the time, was in 
the habit of smoking, sometimes as many as twenty or thirty cigars in the course 
of one day. After a time he was attacked with pain in the region of the 
stomach, and occasional vomiting; in the month of September last, the pains in- 
creased and extended on the left side to the spine, and from thence to the pos- 
terior part of the head — his body and extremities were usually cold— the pains 
were so severe as to prevent him sleeping; and when he did fall asleep, he awoke 
«nrefreshed, and bathed in perspiration, but free from pain; and he continued 
free from it until the next night when the same symptoms returned. On re- 
moving to the country, a month after the commencement of the attack, the pains 
subsided, but sleep did not return — emaciation increased — no food remained on 
his stomach — it was rejected undigested after longer or shorter intervals. 

" In the month of January last, his stomach became more settled — the food was 
no longer rejected— his appetite improved — he began to have good nights, and 
generally found himself refreshed in the morning. About this period, on brush- 
ing his hair, he detected a tumour upon the scalp, which was larger than the 
perpendicular section of an egg — it was painless, colourless, and without any 
feeling of fluctuation; similar tumours, to the amount of eight, subsequently 
developed themselves on other parts of the scalp; within the last month, one 
has formed over the scapular extremity of the clavicle— they are all unaccum- 
panied by pain. At the present time his appetite is extremely good — he sleeps 
well — is capable of taking exercise — but he gains flesh very slowly, not having 
increased half a stone in weight since the severe symptoms subsided." — Dub, 
Med. Press, April 6, 1842. 

Two cases are also related by Mr. W. G. Dvas of this same affection, in 
the Dublin Medical Press, April 13, 1842. 

*'The subject of the first was a man aged about thirty, who had been epileptic 
for several years, but in whom the epileptic paroxysms became less severe, and 
appeared at longer intervals, until at length the original disease lapsed, as it 
were insensibly into, and was superseded by that assemblage of symptoms that 
we term hypochondriasis, the pathology of which is still extremely obscure, 
though the characteristic phenomena are sufficiently obvious, and evidently con- 
nected with a morbidly exalted sensibility of the nervous system, conjoined with 
diminished energy. In this man the tumours were of various sizes — none of 
greater magnitude than a large pea, and the smallest about the size of a duck- 
shot: they appeared almost simultaneously, were moveable, perfectly globular 
and firm, without any discoloration of the skin, and though they appeared in 
greatest number in the upper extremities, yet they existed in the subcutaneous 
tissue of the whole body — they were altogether free from pain, and could be 
pressed between the finger and thumb without causing any uneasiness. In this 
case there was some disturbance of the digestive functions, not more, however, 
than is usually met with in most cases of hypochondriasis. The treatment was 
directed to the removal of the derangement of stomach and bowels, to the resto- 
ration of the functions of digestion, and thus indirectly to the restoration of the 
exhausted energy of the nervous system. With this intent, I prescribed ape- 
rients, enjoined a restricted diet, and gentle exercise, ordered tonics with ammo- 
nia, and the cold shower-bath. Still these measures were not attended with 
success. The subject of this ease then withdrew himself from my care, and 

212 Progress of the Medical Sciences. [Jan. 

entered an infirmary in the neighbourhood of his place o^ residence, where he 
was at once subjected to a succession of warm baths, which, without removing" 
the tumours, had a most injurious effect on his general health: upon his leaving 
the hospital 1 sent him to Dublin, and requested my friend and preceptor, Mr. 
Carmichael, to take charge of him. After this, I had no opportunity of seeing 
the man until nearly two years had elapsed, when I accidentally met him, much 
improved in health; he was then, he said, a stranger to epileptic fits, had no 
symptoms of hypochondriasis, and the subcutaneous tumours had disappeared. 
He said that all his complaints had spontaneously gone off, and he seemed to 
consider himself not much indebted to the profession for his recovery. 

Xhe second case is under my care at present, and, extraordinary to say, is also 
in a hypochondriacal patient. The subject of it is a female aged fifty years. I 
am treating her on the same principles as those on which I treated the former 
case; if, when her health be improved, I find the tumours remaining, I propose 
to try small doses of mercury in combination with iodine. I have thus confined 
myself to a simple detail of facts, without pretending to give any explanation of 
them, or to theorize on a subject where we are so scantily supplied with mate- 
rials for speculation. 

34. Fracture of the Clavicle caused hy muscular action. — The Revue Medicale for 
March 1841, contains an account of a case of this kind, copied from the Revista 
Medica, No. 1, 1841. The subject of the case was a colonel of cavalry, about 
sixty years of age, whose health was somewhat impaired by repeated attacks of 
syphilis. In mounting his horse, he experienced a sensation as if something 
had broken, followed by acute pain in his left shoulder, and on examination it 
was found that the clavicle was fractured in the middle. 

35. Gangrene produced hy the Immovable Jlpparatus applied for fracture of the 
•fore-arm^ in a child. — In our No. for Feb. 1840, p. 460, we recorded several 
cases in which unfortunate results followed the use of the Immovable apparatus. 
The following is another example of the same character. 

Case. — A child, ast. 12, of delicate constitution, fractured both bones of the 
fore-arm by a fall from a carriage; the surgeon applied the ordinary apparatus, 
which he had previously moistened with clean water; this tightened application 
caused horrible sufferings during four days, when the surgeon replaced it by 
the starched bandage, which was less tight than the first, so that it was more 
easily borne; nevertheless, two days afterwards, dark vesications showed them- 
selves at the extremities of the fingers, and on the 12th the patient was brought 
to the Hotel Dieu, with well-marked gangrene of the hand and lower part of 
the fore-arm. On the following day amputation of the fore-arm was performed. 
The patient ultimately recovered. — Med. Chir. Rev., Oct. 1842, from Gaz. Med. 
de Paris. 

36. On Contusions of Muscles. — By Wm. Allison. The most interesting cir- 
cumstance connected with contusions of muscles is the difficulty of distinguish- 
ing those injuries from dislocations or fractures of those bones which form cups 
for* joints. Muscles are bruised by falls or blows; a limb is consequently stiff 
(whilst lengthened or shortened,) and it becomes motionless at a joint, so that 
neither flexion nor extension can be performed by the subject of the accident; and 
sometimes considerable swelling ensues before a medical man arrives. The sur- 
geon's attempt to move the limb, in order to ascertain the nature of the injury, 
produces a painful spasmodic action of muscles, sometimes without proving 
advantageous to himself, in his endeavour to find out the precise cause of the 
loss of muscular action and the stiffness of the limb. And whilst the surgeon 
has no means of completely satisfying himself with respect to the accident, he is 
closely questioned by the patient and his friends, and must either express his 
doubts or give indirect answers. We all know that by sleeping with the head 
upon the arm, so as to make good pressure on the median nerve, we may become 
unable, during many minutes after w^aking, to move the fore-arm; that by sleep- 

1843.] Surgery. 213 

mg cross-leg-cred in a chair, so as to make a firm pressure upon the popliteal 
nerve, we may be, during many minutes, unable to stand upon the leg; that 
rheumatic stiffness may require great muscular efforts to restore the use of the 
limbs; and that sometimes after fractures of the arm or ihigh, one means only 
can overcome the muscular rigidity, and restore action — namely, the frequent, 
resolute efforts of the patient himself to put the muscles in action; but I think it 
behoves us especially to ascertain the different effects and the practical conse- 
quences of violent muscular contusions. 

1. The muscle or muscles may be so bruised as to be simply benumbed (with 
tonic or permanent contraction or with relaxation), the nerves being affected by 
the fall or blow, something like the brain from concussion. 

Case I. — Mr. Smith, of this town, remained with his leg, for half an hour, 
under a horse which had fallen with him, and which had then laid upon him, 
the horse having made fruitless attempts to get up whilst the leg was under 
him. Mr. Smith could not move his leg when first lifted up; but, being sup- 
ported, he made great efforts to use it, until in ten or fifteen minutes he gradually 
became able to walk. 

Case II. — A woman, named Parkin, of Ordsall, fell from a load of hay upon 
the hard ground, in a very hot, dry summer; her thigh was for some weeks in the 
exact position of a dislocation into the ischiatic notch. By forcible extension I 
could place the limb in the natural position without pain; but it always returned 
to the apparently dislocated position. No fracture of the acetabulum nor of the 
neck of the thigh-bone could be felt. In four or five weeks she recovered the 
use of the limb. 

2. The muscles may be bruised whilst in action, and remain stiff (with atonic 
contraction or with relaxation) so long as they are left at rest; but the moment 
an attempt is made by the patient or surgeon to move the limb, a violent, pain- 
ful quivering or irregular spasmodic action comes on, and the limb cannot be 
placed in the natural position. 

Case 111. — A boy was carrying two pails full of water, suspended from his 
shoulders; in attempting to step down with them, from a very highly-raised 
causev/ay, he slipped backwards and sideways upon the edge of the causeway, 
shooting his heels before him. On my arrival his leg presented the appearance 
of a dislocation upon the pubis. Every attempt to bring that knee to a level with 
the other, either on a mattrass or when standing upon the sound limb, failed; 
but it produced painful, spasmodic muscular action. The chief pain was in the 
groin, where there w^as a swelling; but as the head of the ihigh-bone could not 
be felt there, I proclaimed the accident to be "a serious injury of the muscles," 
which probably would continue some weeks. By leeches, fomentations, &e., 
the boy recovered in a week. 

3. Muscles may be bruised, with extravasation or some injury ending in sup- 

Case IV. — I was called (July 1) to a lady who had been thrown out of a pony 
carriage in this town; her shoulder was dislocated, and her leg was bruised. 
Both before and after the dislocation was reduced she walked twenty or thirty 
yards very well, and she was sent home, a few miles off, in a chaise. The leg 
swelled, and became stiff and useless (to herself immovable). After leeches, 
fomentations, poultices, &c,, had been used, with entire rest for upwards of 
five weeks, she became alarmingly ill, with high constitutional disturbance 
during her seventh month of pregnancy; and in about a week from that time (on 
the 17th of August) I opened a deep-seated abscess under the fascia of the gas- 
trocnemius muscle, after which she became perfectly well, before her confine- 
ment (on the 17th of October), from which she recovered as usual. 

4. Muscles may be bruised, with a laceration of fibres. 

Case V. — In June, 1839, I was desired to visit a stout, heavy, muscular man, 
who, it was supposed, had dislocated his hip. On my arrival I heard that, 
whilst sitting upon the shelvings of a cart, he fell backwards with his shoulders 
upon the wheel, and reached the ground (hard sand-rock) in about the sit- 
ting position. Moving the limb gave excruciating pain, and occasioned spas- 

214 Progress of the Medical Sciences. [Jan. 

modic muscular contraction; nevertheless, after having placed his shoulders and 
hips in a straight line upon a mattrass, and having- grasped each ancle with one 
hand, 1 drew him downwards towards the bottom of the mattrass, when I found 
the inner ancle-bone of the injured side full an inch and a quarter below the 
other, with the heel inclining inwards. I could bend the knee upwards towards 
the abdomen, but could not cross one thigh over the other. Adduction could be 
effected with some difficulty; but this limb was always longer than the other by 
an inch and a quarter, with the knee separated, and the toes turned outwards 
when in the easiest position, and there was a constant pain in the perineum. If 
the case had been one of dislocation into the foramen ovale, I supposed adduction 
could not have been effected, and I was not aware that it could be any other 
variety of dislocation. There was no crepitus about the joint; 1 therefore be- 
lieved it to be lengthening of the limb, mentioned by the late Sir A. P, Cooper, 
and delivered my opinion decisively, "that there was not any dislocation." 
However, I felt much more satisfied after my partner had accompanied me on my 
next visit. To the question, " What is the accident?" we replied, "a rupture of 
some part of the muscle which forms the buttock." 

The gentleman was bled in the arm, took an opiate, had his hip fomented, and 
warm, damp linen kept upon the painful part; he then took castor oil; on the 
following morning twelve leeches were applied, and afterwards poultices. We 
cannot lift patients so affected into and out of warm baths; he was kept in the 
easiest posture, &c., and the case went on quietly; but the lengthened state of the 
limb, the inability to move it without violent pain for some weeks, and the 
sensation of something in the perineum, gave rise to doubts amongst his friends 
respecting a dislocation. In this case extension of the rigid muscles after the 
second week, by pulleys applied as if for a dislocation into foramen ovale, until 
fainting was produced, appeared to be serviceable. The consequences of the 
accident were, not only that the limb gradually became of the same length as 
the other, but that contraction went on until it was about an inch shorter, as it 
remains to this day, that he halts in walking, and that he cannot ride on horse- 
back witiiout making the hip and thigh muscles very painful. I have on 
several occasions seen limbs as rigid from falls and bruises, when all attempts 
at motion have given violent pain; but in this case 1 cannot account for the 
lengthening and subsequent shortening of the limb, but by a laceration of mus- 
cular fibres. He can now walk ten or fifteen miles in a day without fatigue. 

In relating the foregoing cases, I may not have classed them correctly. For 
instance, the pregnant lady may have had some laceration of the deep-seated 
tissues of her leg, as the carriage wheel had evidently passed over it; but that 
being now doubtful, merely serves to show the difficulty of stating the precise 
extent of injury at the first visit after an accident. 

A surgeon, called to reduce a dislocation, has to distinguish one from a frac- 
ture near the joint; and sometimes, in forming his diagnosis, he is perplexed by 
muscular rigidity; at other times by considerable tumefaction from extravasation 
of blood; and on some occasions by extreme tension from effusion, the conse- 
quence of inflammation. As the late Sir A. P. Cooper, when speaking of dis- 
locations, said, " Few accidents are more likely to endanger the reputation of 
the surgeon, as the patient may become a living memorial of his ignorance." I 
shall not apologize either for having called the attention of surgeons in the com- 
mencement of their career to this particular part of their practice; or for remind- 
ing them further that the biceps tendon may be ruptured, or that it may be dis- 
placed from its natural situation in passing over the head of the os humeri. — 
Frov. Med. Journ., May 28, 1842. 

37. Ununited Fracture treated by rubbing ends of fractured bones together. — Mr. 
WoRTHiNGTON rocords, in the Frov. Med. Journ., (Oct. 29, 1842,) a case of frac- 
ture of both bones of the leg, in a man forty-two years of age, in which, after ten 
weeks no bony union had taken place. The ends of the bones were then rubbed 
together daily for three days, after which the limb was placed in an apparatus to 
prevent all motion, which was removed in six weeks, when union was found to 
have taken place. 

1843.] Surgery, 215 

38. Urinary Calculus — Lithotrity once and Lithotomy twice performed. — An inter- 
esting- case of this is recorded by Mr. R. Elliott, of Chichester, in the Prov. Med. 
Journ. (Oct. 29th, 1842). The patient was a farmer, sixty-three years of a^e, 
with a calculus measuring two inches and a half, by two inches, by the litho- 
trite. In March 1838, Mr. E. in five operations, broke up the calculus, the 
detritus passed easily; all symptoms of the disease ceased, and the patient re- 
mained in perfect health for a year; when he was seized with repeated attacks 
of renal calculi. The prostate beings enlarged, and the bladder irritable, with 
more than one calculus in it, Mr. E. advised, and performed the lateral ope- 
ration, and removed four calculi of triple phosphate, weighing about two 

Nearly two years rolled on without inconvenience, when fresh symptoms of 
stone presented themselves, and in July 1842, Mr, E. again performed the 
lateral operation, and removed a kidney-shaped calculus of the triple phosphate 
formation weighing five drachms. The patient in October last was in perfect 

39. Injections of infusion of Cuhebs in Vaginitis — M. Piorry relates in La 
Gazette des Hopitaux^ (May 1842,) the case of a woman, twenty-three years of 
age, who had suffered nine months from intense urethro-vaginitis, attended with 
acute pain, and an abundant discharge. She had tried every usual remedy for 
its removal without success. M. Piorry ordered an injection made with one 
ounce of cubebs powder, infused in one pint of water, to be thrown into the 
vagina six times daily. In two days the discharge had greatly diminished; but 
the inflammation in the urethra remained intense as before. 8he was therefore 
ordered to take 45 grains of powder of cubebs every hour, and in twelve days 
the pain and discharge had entirely left her, and she was dismissed cured. 

40. False Joint of the Humerus treated successfully by the Seton. By M. Baroni. 
— A man, thirty-seven years of age, fractured his humerus; but, in consequence of 
mismanagement, and the fractured extremities not being kept in apposition, nor 
any means used to keep the limb steady for sixteen days, a false joint was the 
consequence. The fracture was found to be oblique, and the extremities of the 
bone passed each other. The limb was held extended so as to separate the frac- 
tured extremities, and a long needle, armed v^^ith a skein of cotton, was passed 
betv/een the extremities of the bones, and the seton left there. Little inflam- 
matory action was excited; and the limb being imperfectly secured, some weeks 
passed, and still the fractured extremities were disunited. Feverish symptom.s, 
however, soon after this supervened, attributed to exposure to cold; inflammatory 
symptoms attacked the wound, the discharge of purulent matter became abund- 
ant, and a phlegmonous tumour formed in the axilla. The arm was now 
more securely fixed, osseous matter was thrown out, and within two months 
the seton was withdrawn, when the wound rapidly healed, and the fractured 
surfaces became firmly umied.— Ed. Med. Journ., Oct. 1842, from BuUetino 
delle Scienze Mediche, Jan. 1842. 

41. Spontaneous obliteration of the Jlxillary Artery. — Mr. Oke relates an ex- 
ample of this in the Provincial Medical Journal, 23d April, 1842. Several others 
have been recorded by Mr. Turner, in the third volume of the Medico-Chirurgi- 
cal Transactions. 

42. Dislocation of the Tibia backwards. — Mr. C. B. Rose relates, in the 
Provincial Medical Journal j {June 11th, 1842,) the following case of this rare 

" On the 17th of December, 1829, I was hastily summoned to an accident 
which had occurred at the principal inn of this town, situated within fifty yards 
of my own door: a stage coach had been just driven up to change horses, and, 
as is usual, a ladder placed beside and against it; the woman who collected and 

216 Progress of the Medical Sciences, [Jan. 

delivered the parcels had ascended the ladder, and was standing- upon it, when a 
man in a state of intoxication drove furiously against the ladder, upsetting it and 
throwing the woman violently to the ground; she was immediately taken up, 
and carried into the kitchen of the inn; I was quickly by her side, and on exam- 
ining the injured limb, found the tibia completely dislocated at the knee, the 
head of that bone having been driven behind the condyles of the femur into the 
ham, with the patella thrown to the outside of the external condyle of the femur, 
and the leg in a state of fixed extension. 

^ *'I immediately, and without difficulty, restored the parts to their normal 
situation, by applying one hand to the patella, the other to the back part of the 
upper portion of the tibia, and simultaneously pulling and pushing those bones 
into their natural positions. The patient was then removed to her home, a dis- 
tance of about two hundred yards from the inn, and placed in bed. By the em- 
ployment of leeches, evaporating lotions, and strict rest, inflammation was kept 
in check; in short, no untoward symptoms whatever arose, and after the lapse 
of a few weeks she perfectly recovered the use of the joint." 
A similar case is related by Wiseman in his surgery. 

43. Cancer. — The following interesting remarks on cancer are extracted from 
a clinical lecture delivered at the Middlesex Hospital, by Dr. Watson. 

" Cancer is a very obscure disease, and one of the most important subjects 
for the consideration of the pathologist. Its fatality and frequent occurrence, 
the acute pain by which it is generally attended, and its hereditary character, 
combine to render it of extreme interest. But another interest attaches to it, 
from the obscure nature of the organic element of the disease, and from its pe- 
culiar mode of growth. Recently much light had been thrown upon the subject, 
and it is to be hoped that still greater light is about to be thrown on it, for all 
pathologists looked with anxiety to the result of Mr. Kiernan's investigations, 
which I believe will shortly be placed before the profession. In the 'Lancet,' 
Dr. William Budd, of Bristol, has published two very interesting papers, to 
which I would direct your particular attention. They were published in two 
consecutive numbers of that journal for May last, and they are written, as every 
thing from the pen of Dr. William Budd, extremely well. Whatever may be 
the causes of cancer, it appears to be clearly ascertained that, however numerous 
or distant from each other the parts affected by it, the infection proceeds from 
one original tumour. It often occurs that the disease manifests itself in different 
parts of the body, sometimes contemporaneously, sometimes at different periods. 
But all those are but branches of the same malady. Generally speaking, the 
internal parts are affected at a period subsequent to the appearance of the disease 
externally. Dr. Budd has directed attention to the progress of cancer under 
some of its ordinary phases. Let us state an example: a small, hard knot is 
detected in the female breast, lying loose in that organ; this tumour enlarges, 
grows, fastens on the parts around, no longer lies loose in the cellular tissue, 
but contracts adhesions with the surrounding parts, spreads out its claws, as it 
were, like a crab (hence the name cancer), seizes on the glands of the axilla, 
and disseminates small tumours through the viscera. On examination after 
death, cancerous matter is detected in the viscera and lymphatic glands, and is 
frequently found in the lungs, the liver, and peritoneum. From these facts, and 
from the circumstance that the veins are found charged with the same cancerous 
matter. Dr. Budd infers (and a most important inference it is, if drawn from a 
sufficient number of authenticated facts) that the secondary tumours discovered 
in the viscera, and other parts so diseased, are derived from the first tumour — 
are caused by seeds from the primary or parent growth, conveyed by the blood 
to those localities, and form themselves new centres for the further dissemina- 
tion of the complaint. Some curious results of the microscopic investigation of 
cancerous matter are adduced in aid of this hypothesis. The labours of Miiller, 
who has investigated the minute anatomy of cancer by the help of the micro- 
scope, show that the substance of cancerous tumours is a soft kind of pulp, held 
loosely together by a fibrous web. The pulpy matter presents an organized form 

1843.] Surgery. 217 

of an extremely interesting kind, beinor found to be almost entirely composed of 
minute globular cells, containing within their cavities a vast number of very 
minute granules. Similar cells are found in the organization of portions of the 
vegetable kingdom. Those granules are supposed to be what are called cysto- 
blasts, or germs of new cells, and becoming detached from their parent cells, 
are carried about until deposited in some place where, from their size, they are 
unable to pass through the smaller capillary vessels, and there they become 
parent cells, and engender new growths. This is a consideration of immense 
practical importance, as if, fully established, it would of itself demonstrate the 
necessity of immediate removal of the first cancerous tumour by the knife, and 
of its complete removal. The timely extirpation of cancerous growths is thus 
indispensable. In very many cases removal by the knife has proved fully suc- 
cessful in wholly eradicating the disease: in many cases it had not been suc- 
cessful. But in the latter it is inferred that the removal of the cancerous matter 
had not been complete — that either the operation had been deferred until the 
germs had been disseminated, or that the knife had not removed the whole of 
the diseased matter. So very minute are those germs, that it is altogether im- 
possible to detect them unless by means of microscopic power; and Dr. Budd 
recommends that the cut surface should be subjected to microscopic examina- 
tion, as if on that surface he found any of those cells, the clear inference is, that 
others have been left behind, and consequently that the removal has been in- 
complete. In those operations the surgeon should cut away not only enough, 
but what may be called more than enough. 

"This subject, gentlemen, is altogether most interesting; bnt it requires 
further examination. What the exact nature, and what the origin of those 
minute cells, are as yet uncertain; they may be termed a sort of hydatids. They 
appear, like plants, gifted with an independent vitality, possessing the power of 
generation, increasing and multiplying prodigiously, and capable of being con- 
veyed to remote distances from the parent growth, without losing their character 
or powers; they might indeed be appropriately called a sort of parasitic animal. 
What is the origin of the primary or parent growth, it is, at least as yet, impos- 
sible to say. Some authors contended that cancer is infectious and contagious. 
Dr. Budd states that Langenbeck injected cancerous pulp from a living body 
into the veins of a dog; the animal after some time wasted away and died, and 
on examination several cancerous tumours were found in his lungs. Soot is 
supposed to be a cause of cancer, and one species of that disease is known as 
chimney-sweeper's cancer. Dr. Budd has alluded to cases of cancer of the 
penis in men, whose wives laboured under cancer of the uterus, which would 
tend to establish the doctrine of its being contagious. The germs of cancer 
clearly possess an independent vitality, and are like parasitic animals, or a kind 
of fungous growth, perhaps somewhat resembling the disease known as scald 
head, which is now held to depend on a sort of cryptogamic plant, the habitat or 
one of the habitats of which is the human head. As I totally disbelieve the doc- 
trine of spontaneous generation, I cannot yield to the suggestion that these 
germs originate in the body, but am of opinion that they are introduced by some 
yet unascertained mode. The introduction of insects into the human frame by 
unknown means is familiar to us all, and from all that is known I am induced 
to believe that cancerous matter is similarly introduced. In conclusion, I 
would again impress on the student the necessity of pursuing this important in- 
vestigation, and again strongly recommend to him a careful perusal of the whole 
essay of Dr. Budd, as most interestmg and instructive." — Provincial Medical 
Journal, Oct. 29th, 1842. 

44. Femoral Aneurism— operation — recovery. By James Svme, Prof. Clin. 
Surg.—William Garrick, aged 17, from Shetland, was admitted into the hospi- 
tal on the 20lh of May, 1841, on account of an aneurism of the femoral artery. 
He stated that, in the latter part of February, when cutting a piece of wood, 
with the large knife used by seamen, he had accidentally thrust the blade into 
the inner side of his left thigh, a little below the middle. A great gush of blood 

218 Progress of the Medical Sciences, [Jan. 

immediately sprung out, but was speedily arrested by the pressure of four half 
crowns which he had the presence of mind to apply firmly over the wound. In 
a few days, the bandagfe beinof taken off, it was found that the wound had healed, 
and nothing unusual was noticed until a week afterwards, when he perceived a 
sort of thrilling sensation at the injured part. This increased daily, and in the 
course of another week, a pulsating tumour, the size of a small hen's egg, was 
noticed; he still took no alarm, but finding that the tumour progressively in- 
creased, at length applied to a surgeon, who explained the nature of his case, and 
sent him off to P^dinburgh. 

When admitted, he complained of coldness in the limb, which was also 
slightly cedematous, notwithstanding the support of a flannel bandage, which 
had been put on before he left home. The tumour was about the size of a goose's 
Go^^t had a strong, uniformly distending pulsation, though not very distinctly de- 
fined, and lay under the lower edge of the sartorius. The sac could be readily 
emptied by pressure, either directly over it or on the trunk of the artery at the 
brim of the pelvis, so as to make all trace of the swelling to disappear. 

It was thought, in this case, that simple ligature of the femoral would not 
prove sufficient for effecting a cure; and that, as in brachial aneurism, from 
wounding the artery in venesection, it would be necessary, after opening the sac, 
to tie the vessel on both sides of its aperture; but for my own part, I did not de- 
spair of success, from merely obstructing the artery above the tumour, since the 
anastomosing circulation beyond it was much less free than at the bend of the 
elbow. At the same time 1 greatly dreaded the danger of conveying ligatures 
round the artery, where it lay within the sac, in close proximity to the vein, or 
not improbably almost incorporated with it by the pressure of the blood. 1 there- 
fore resolved to try the effect of simply tying the femoral in the ordinary way, 
as this proceeding seemed to be safe in itself, and in the event of failure, pro- 
mised to present no obstacle to adopting the other alternative. 

The operation was performed on the 26th; the pulsation ceased immediately and 
completely, without any return; the swelling diminished daily; the ligature sepa- 
rated on the 14th of June (the eighteenth day); and the patient went home cured 
on the 23d of the same month. — Lond. and Edin. Monthly Journ. Med. Sci.,, Nov. 

45. Artificial Jlnus. — Mr. Alfred Jukes, surgeon to the General Hospital, 
Birmingham, has performed the operation for the formation of an artificial anus 
in the loin, in a case of carcinomatous stricture of the rectum. The patient, a 
woman 30 years of age, lived sixteen days after the operation, during which 
time " the bowels acted freely, and were relieved from every sign of obstruction 
by the artificial aperture." Death was attributed to chronic inflammation of 
the peritoneum. We have been favoured with a report of the case, and shall 
notice it more particularly in our next number. 

46. Hetro'pharyngeal Abscess. — The infrequency of a collection of pus in the 
submucous cellular tissue behind the pharynx, the obscurity of the symptoms, 
and the danger to life caused by the existence of a retro-pharyncjeal abscess, 
render it a subject of great importance and interest. M. Mondiere has collected 
a series of these cases, drawn from various authors, which may serve to remove 
in part the obscurity that hangs over the semeiology of this disease. Out of 18 
patients, 11 were adults, and the remaining?, children from eleven weeks to four 
years old. In three cases, the abscess was caused by the existence of an inflam- 
mation of the mucous membrane of the pharynx, which had been propagated to 
the sub-mucous cellular tissue. The retrocession of erysipelas appeared to have 
produced it in another case; in two others it seemed to depend on rheumatism, 
and in one to have been caused by a stricture of the oesophagus just below it. 
Caries or tubercular disease of the cervical vertebrae is another cause, the abscess 
being merely symptomatic. Several examples of this have been placed on re- 
cord, but, in examining the part, the simple erosion of the bone caused by the 
prolonged contact of the purulent matter must not be mistaken for caries. 

1843.] Surgery, 219 

The prou^ress of these abscesses is generally acute, the symptom of suffoca- 
tion, however, not showing itself until the abscess is fully formed. The collec- 
tion symptomatic of caries must necessarily be chronic in its formation, and 
nevertheless the dyspnoea and dysphagia come on suddenly, in conformity with 
the pathological law, that a gradual compression may be exercised with im- 
punity for a long while on organs the most essential to life, no symptoms being 
produced until the pressure had been carried beyond a certain amount. 

The termination of these abscesses is not fatal when they have been recog- 
nised and opened early. Death occurred only once out of thirteen cases where 
the abscess was opened, but if the disease is mistaken, death is almost inevita- 
ble, either from suffocation by pressure, or from its bursting into the trachea or 
chest. Examples are recorded by Messrs. Mott, Manoury, Dariste, Petrunti, 
and Mondiere. 

The primary symptoms are, local pain and an injected state of the pharyngeal 
mucous membrane with or without fever, and followed by difficulty of swallow- 
ing or breathing. At the end of a certain lime another set of symptoms show 
themselves, resulting from the formation and accumulation of pus, such as ir- 
regular shiverings, oedema on the sides of the neck, more or less tumefaction of 
the posterior paries of the throat, and threatened suffocation. To these Petrunti 
adds displacement of the larynx forwards. 

The diagnosis would not be attended with difficulty if the surgeon were to 
think of the possibility of such an abscess forming, and to examine the posterior 
part of the fauces, as the tumefaction is so well marked. The dyspnoea, how- 
ever, so closely resembles that of other complaints, that the existence of an ab- 
scess may not be suspected. The complaint it most closely resembles is croup, 
from which it may be distinguished by the symptoms in croup not being con- 
tinuous, while they are so in the retro-pharyngeal abscess, although they have 
an occasional exacerbation. Besides, the difficulty of breathing and the agita- 
tion of the patient are increased by pressure on the larynx, which is not the 
(jase in croup. The dysphagia also increases at the same time with the dyspnoea. 
The safest plan, however, is to examine the interior of the throat with the finger, 
an exploration that should be made in all diseases resembling croup or oedema of 
the glottis. 

The only indication with regard to the treatment is to give a speedy exit to 
the pus, which should be done as soon as fluctuation is evident, either with a 
bistoury or pharyngotome. Mr. Fleming uses a trocar that he has had con- 
structed for the occasion, but it has the inconvenience of the opening being liable 
to close, and thus requires repeated punctures. Dupuytren advises a large inci- 
sion to be made. When the mouth cannot be opened sufficiently wdde for an 
instrument to be used with safety, it would be advisable to burst the abscess 
either with the finger or the handle of a spoon, pressing gently at the same time 
with the thumb and fingers on the side of the neck on a level with the larynx, 
to prevent the matter spreading laterally; or a pair of scissors may be used, one 
blade being sharp-pointed and shorter than the other, which should be blunt 
The instrument may be passed closed to the back of the pharynx, then the sharp 
blade separated, thrust into the abscess rather obliquely, and the blades being 
closed, a free incision would be readily made without danger.— Proz;. Med. 
Journ. Oct. 15, 1842, from ^Experience. 

47. Syphilitic Retraction of the Muscles. — This is a disease of rare occurrence, 
and which has only of late received attention. It affects most frequently the 
flexor muscles of the fore-arm, if we may be allowed to form on opinion from 
the generality of cases observed at the venereal hospital, under M. Ricord. 
The three patients who presented this remarkable affection had arrived at that 
point of constitutional infection characterized by the symptoms which are de- 
nominated tertiary by M. Ricord. In all these the retraction was very similar; 
the flexors of the fore-arm being affected by it. The muscles appeared short- 
ened, as a result of the permanent contraction, which did not permit the exten- 

220 Progress of the Medical Sciences, [Jan. 

sion of the fore-arm; but their tissue, though firm, presented no appreciable 
alteration. An important symptom was the peculiar pain which existed in the 
contracted part; this pain was increased at night, and resembled closely that 
experienced in syphilitic affections of the bones. In one of the patients the re- 
traction was cotemporary with tertiary ulcerations of the throat; in another, 
with periostitis of the tibia. These patients were submitted to the treatment 
of iodide of potassium. The success, under its influence, was as prompt and 
easily obtained as in other tertiary symptoms. The pains ceased in each one 
as soon as the fifth or sixth day. The movements of the limbs underwent a 
progressive amelioration, and were soon perfectly restored. — Lond. Med. Gaz,^ 
July, 1842, from Bull, de Therapeut, 

48. Treatment of Umbilical Hernia in children hy Ligature. — A child, aged ^ 
eight months, was brought to M. Bouchacourt suffering under umbilical hernia, 
which had been observed a few days after birth: various means had been em- 
ployed to keep the swelling reduced and to effect a cure, without producing any 
benefit. The hernia easily protruded, and formed a considerable swelling. When 
it was returned, the finger readily entered the unobliterated ring, and felt its 
smooth and regular edge. The operation was conducted as follows: — The child 
being secured and the hernia returned, the surgeon assured himself by careful 
examination that no intestine or other viscus remained in the sac, by rubbing its 
sides against one another between the finger and thumb. Keeping up a pressure 
with the finger close by the ring, to prevent the protrusion of any part into the 
sac, a needle armed with double thread was passed through the base of the pro- 
jection in the integuments into which the hernia protruded, as into the finger of 
a glove, and the threads being separated, each was tied upon the corresponding 
half of the swelling. The base was also enveloped by a third thread, carried 
round tire whole, and drawn tight. The child did not appear to suffer much — 
only a sma)l piece of lint was placed on the part. The first night the infant cried 
and slept little, but afterwards went on well, with the exception of slight fever 
in the evening and a diminution of appetite, no alteration being observed in its 
other functions. The stools were regular, and it had no vomiting. After a few 
days the encircled part swelled, sloughed off, leaving a considerable ulcer. In 
two months and two days after the operation, a very small surface remained un- 
healthy, giving vent to a discharge which scarcely tinged the linen. The ring 
appeared to be obliterated. The hernia had not returned, and from the day on 
which the ligature was applied, the swelling had not once shown itself, notwith- 
standing the efforts and cries of the child. — Lond. Med. Gaz., July, 1842, from 
Revue Medicale. 

49. Passage of Mr into the Veins. — Dr. Asmus was removing a steatoma as 
large as the two fists from the region between the lower jaw and clavicle of a 
man forty years old, and was very carefully separating its base from the carotid 
artery with which it was in contact, when he accidentally opened the internal 
jugular vein, which had been pushed far from its usual place by a lobe of the < 
tumour. No blood flowed; but on the instant he heard the air enter the vein 
with a bubbling sound. He asked the man how he felt, who said "Well;" but 
the next moment cried out, " Its all up!" and began to be convulsed, first in the 
face, and then in the whole body. He sank down, and at the same instant 
another bubble was heard; but still no blood flowed. Alternate convulsive 
movements and opisthotonos ensued; the face was deadly pale, the breath short, 
and death seemed close at hand. Rapid bleeding now took place from the 
wound, and a stream of black blood was seen to issue from the vein, but as often 
as the patient was convulsed, air again passed in, and the bubbling was dis- 
tinctly both seen and heard. A ligature was as quickly as possible put upon the 
vein above the injured part, and with this the bubbling ceased; the tumour was 
cut off level and the patient was put to bed. 

Syncope, alternating with severe convulsions, still continued; the pulse was 
not discernible, the heart seemed only to vibrate, and the respiration was short. 

1843.] Surgery, 221 

Stimulants and a variety of restorative means were employed, and about twelve 
hours after the operation (in which the loss of blood was altogether moderate,) 
the patient began to revive. His condition continued to improve, and he at 
length completely recovered. — Brit. ^ For. Med. Rev., from Medinische Zeiiung, 
June 8, 1842. 

50. Intra-parietal Hernia after a Wound of the Abdomen. — M. Berard details 
in a clinical lecture, a good example of an accident which is apt to occur not 
only in penetrating wounds of the abdomen, but in operations for hernia. In 
the endeavour to force the intestine (which had protruded) back into the abdo- 
men, it was pushed up between the layers of the abdominal muscles, and here, in 
the cavity thus artificially formed, became strangulated. The case was the more 
perplexing, because, when the intestine was in this position, the finger could 
be easily passed into the abdomen, and the intestine seemed to be entirely re- 
duced. — Ibid, from Gazette des Hopitaux, June 28, 1842, 

51. Case of Strangulated Hernia through the foramen thyroideum. Cy Dr. 
Frantz.— The patient was a strong woman, forty years old, whom the autlior 
found with many of the signs of strangulated hernia, and complaining of a severe 
pain at the upper and inner part of the left thigh, which had come on suddenly 
and was increased in paroxysms at intervals of about ten minutes. There was 
no redness, heat, or swelling at the part, but on pressing the point of the finger 
high up between the triceps and adductor muscles, severe pain was produced. 
There was pain, but no tenderness, of the abdomen. The patient had long had 
double femoral hernia, but neither of these was now down. Three years before, 
she had had signs exactly like the present, but had been suddenly relieved when, 
as she was pressing upon the part, something seemed to go back with a noise 
into the abdomen. Since that time the same symptoms had occasionally re- 
curred in a less degree, but they had been always relieved by the same plan of 
pressing, as if to reduce a hernia. On the present occasion, however, they were 
much more severe; bleeding, purgatives, repeated applications of pressure, and 
various other remedies were tried in vain. On the fourteenth day the signs of 
strangulation havincr recralarlv increased, and stercoraceous vomiting havino- 
existed since the ninth, the patient seemed to be quickly dying, when, to the 
surprise of all, a spontaneous evacuation or faeces took place, and she began 
slowly to recover. Her recovery was ultimately complete. — Ibid, from Jlllege- 
meine Med. Central-Zeitung^ April 27, 1842. 

52. Observations nn Fibrous Polypi of the Uterus. — On the occasion of a patient 
labouring under polypus of the uterus being admitted into the hospital, M. Be- 
rard made some observations on the management of these growths. — The patient 
was a single woman, forty-seven years old, who had good health, and menstru- 
ated regularly from the age of eleven to twenty-four. From that time, however, 
till her forty-fourth year menstruation became very scanty, but afterwards re- 
turned, being exceedingly abundant, and at length flowed continually in greater 
or less quantity. From this constant loss of blood the patient became at length 
much exhausted, and was admitted into the hospital in a state of complete anae- 
mia. An examination per vaginam discovered the neck of the uterus to be dis- 
tended, its orifice directed to the left side and slightly open, and the lips of the 
OS uteri were thinned, and its cavity was occupied by a rounded oblong tumour, 
which was ascertained to be attached to the interior of the uterus. 

With reference to the symptoms that were observed, M. F3erard remarks that 
Levret is mistaken in supposing that hemorrhage occurs only when the tumour 
having cleared the cervix uteri and descended into the vagina, the circulation 
in it becomes impeded by reason of the constriction of the polypus by the neck 
of the uterus. He is on the other hand disposed to regard these hemorrhages 
as active, and analogous to those which take place during the course of abor- 
tion, an analogy the more strongly marked, since in the one case as in the other 
uterine contractions take place. From a consideration of the symptoms he 
No. 1X.--January, 1843. 15 

222 Progress of the Medical Sciences. [Jan. 

proceeds to an inquiry into the proper treatment, and decides in this case in 
favour of excision rather than of the ligature. Tlie dangers of excision he 
regards as trivial, while the great superiority which it possesses over the liga- 
ture in the speedy removel of the growth is universally admitted. 

The operation, which proved completely successful, was performed by placingr 
the patient in the position for lithotomy. Two assistants kept the thighs pro- 
perly bent, while a third made pressure on the hypogastric region. The opera- 
tor having introduced a bivalve speculum, incised the two commissures of the 
cervix uteri with a probe-pointed bistoury, which permitted the polypus to 
enter the vagina. The speculum was then withdrawn, and two hooks being 
placed in the tumour it was gradually drawn down to the vulva. The operation 
was then completed by excising the pedicle of the polypus with a pair of curved 
scissors. The patient perfectly recovered. — Ibid, from Gazette des Homtaux^ 
Jan. 8, 1843. 


63. Mechanical Lesions of the Eye. — Dr. O'Beirne has published in the Dub. 
Med. Press a curious case in which a small nail was accidentally driven into the 
eyeball, and lodged there for many days. 

The patient, a woman, said that, while shaking a carpet, she felt something 
sharp strike with force against her right eye. She became sick immediately, and 
shortly afterwards she found on her apron a gelatinous substance, which is sup- 
posed to have been the lens. When admitted into the hospital, there was so 
much tumefaction and ecchymosis of the eye that the cornea could scarcely be 
perceived except at one point, where there was seen to be a depression, from 
which a bloody fluid oozed out. There was no appearance of any foreign sub- 
stance in the eye; and indeed the woman herself said that the nail had beea 
found on the carpet. In spite of the most active antiphlogistic treatment, the 
inflammation and suffering increased for nearly a fortnight: and then an eschar 
formed about the centre of the cornea. Upon making a puncture there, a con- 
siderable quantity of purulent matter flowed out with decided relief to the symp- 
toms. Dr. O'B. while making the puncture, thought that he felt the point 
of his lancet strike upon a hard substance, and therefore suspected that some- 
thing was lodged in the eyeball. On the following day, his suspicions were 
confirmed; and he then extracted, not without some difficulty, a flat-headed nail 
of about three quarters of an inch in length. The inflammation quickly sub- 
sided; but, as a matter of course, the sight of this eye was irrecoverably lost. 

MM. Cunier and Stievenart have related cases in the first vol. of the Annates 
d^Oculistique, where fragments of fulminating capsules had been driven into the 
eye. In one case an entire capsule was extracted between two and three months 
-after the occurrence of the accident. — Med. Chirurg. Rev. July, 1842. 

54. Wounds of the Supra-ciliary Region. — M. Constatt has, in the first vol- 
ume of the Jlnnaks d^Oculistique., established by numerous historical and ne- 
croscopic researches that the blindness, which sometimes follows wounds of the 
^upra-ciliary region, is, in almost every case, owing to some other cause than to 
an injury of the frontal nerve, as is usually imagined. M. Walther, in a recent 
number of the Journal der Chirurgie und Jlugenheilkunde, alludes to several 
cases in which no blindness occurred, although this nerve had been positively 
divided either accidentally, or designedly, for the relief of neuralgia. 

When loss of sight follows wounds about the forehead, he is inclined to attri- 
bute it to some simultaneous derangement of the organs contained within the 
orbit or the cranium, and not to any direct injury of the frontal nerve. 

M. Walther endeavours to show that there is no direct communication between 
the frontal nerve and either the optic nerve or the retina; that even with the 
ciliary system of nerves its communication is only indirect through the medium 

1843.] Ophthalmology, 223 

of the nasal nerve; and that impressions on it, (the frontal,) are transmitted to 
the eye through the medium of the encephalon. According to this view, there 
is therefore no direct, but only a reflex, continuity of action. 

The nutrition of the eye is disturbed by any lesion of the ganglionary ner- 
vous filments, virhich are distributed on this organ. Thus diseases of the neck, 
or operations performed in this part, will sometimes produce ophthalmia, or 
even an atrophy of the eye. If, then, says M. VVallher, lesions of the great sym- 

Sathetic nerve have so marked an effect on vision, why should not an injury of ji 
ranch of the trigeminus, which is well known to be so intimately connected 
with the eyeball, produce the same results'? 

The French Medical Gazette adds to its analysis of M. Walther's paper a 
case where blindness followed a slight wound of the forehead, although there 
was no obvious commotion either of the eyeball or of the encephalon. The 
blindness in this case was owing not to amaurosis but to the presence of a cata- 
ract: in consequence probably of the nutrition of the eye being disturbed. — Med, 
Chirurg, Rev. July, 1842. 

55. Exophthalmia, with (Edema of the Conjunctiva^ and Opacity of the Crystal- 
fine Lens in a Puerperal Woman. By M. Blandin. — A woman forty-one years 
of age, was delivered, after a tedious labour, on December 3d, 1841. For fifteen 
days no unusual symptom occurred, but on the sixteenth and seventeenth day 
the patient was attacked by a violent shivering fit. On the eighteenth day, how- 
ever, she returned from the hospital to her own home, and for some days after- 
wards suffered from febrile attacks, though they were no longer preceded by 
severe shivering. From the 25th of December the right eye began to project, 
the patient suffering little beyond a sense of weight in the head, principally ia 
the supra-orbitar region. Vision was at first unimpaired, but failed as the ex- 
ophthalmia increased, and at last the patient became quite blind of that side. In 
this condition the patient applied to M. Blandin, at the Hotel Dieu. Tliere was 
then considerable prominence of the right eye, the conjunctiva of the globe was 
prominent, red, and swollen, and evidently infiltrated. The cornea was natural, 
the aqueous humour retained its transparency, and there was no evident change 
in the structure of the iris, but it had lost its contractility, and the eye was unin- 
fluenced by exposure to a strong light. The crystalline lens appeared opaque, 
and of a shining, milk-white colour; the anterior membranes of the lens being in 
all probability the seat of the opacity. The volume of the globe was normal, 
the pain in the affected parts was inconsiderable, and no tumefaction existed of 
the parotid or cervical glands. The intellectual faculties were perfect and the 
general health was good. 

In his remarks on the case M. Blandin offers some observations on the diag- 
nosis of the affection. Some ramifications of the conjunctiva gave exit to a small 
quantity of pus from its inferior external portion. From that time the eye gra- 
dually retreated into the orbit, and from these circumstances M. Blandin con- 
cludes that there existed a small abscess behind the eye. The cause of the 
formation of this abscess is open to debate. It might be one of those purulent 
deposits occasionally met with in puerperal women. M. Blandin, however, re- 
gards it rather as the result of phlebitis, probably of the ophthalmic vein. He 
is likewise disposed to regard the affection as altogether analogous io phlegmasia 
dolens, in which disease the femoral vein becomes obliterated, just as here, in all 
probability, the ophthalmic vein was. On any other supposition the opacity of 
the capsule of the crystalline lens does not admit of explanation; while, in two 
other instances in which this lesion of the ophthalmic vein was discovered after 
death, precisely this condition of the crystalline lens had been noticed during 
the lifetime of the patient. — British ^ Foreign Med. Rev., Oct. 1842, from GazeU* 
des Hopiiaux, Jan. 27, 1842. 

56. Treatment of Leucoma by Incisions into the Cornea. By D. Holscher. — 
Two cases are related in which this treatment was adopted. The case which 
suggested it was that of a girl, twenty-two years old, who had lost the left eye 

224 Progress of the Medical Sciences. [Jan. 

from purulent ophthalmia in infancy, and in whom the right was almost blind 
from ieucoma of nearly the whole cornea. Various means had been used in 
vain. The author, therefore, made an artificial pupil by drawing the iris 
through the cornea and excising a portion of it. Severe inflammation ensued 
which was with difficulty managed; but three months after, the patient not only 
had a good artificial pupil, but the cornea had become much less leucomatous, 
and this especially at the part where the incision through it had been made. 
The next bad case of Ieucoma, therefore, which the author met with, he treated 
as follows: the patient was a lad fourteen years old, who had lost his right 
eye from purulent ophthalmia in infancy, and had Ieucoma of nearly all the 
left cornea. At four diflferent times, with intervals of eight days, a common 
cataract knife was passed into the cornea as deep as possible without pene- 
trating it, and was drawn out with a sliding motion. After the first three times 
no inflammation ensued; therefore, after the fourth, some tinct. opii was dropped 
into the wound three times a day. Severe inflammation set in, but it was mode- 
rated by local bleeding, and the treatment by opium was continued for two 
months. The Ieucoma became gradually less, and the patient who could at first 
only discern light from darkness, became able to guide himself in walking, and 
to perceive the window-frames in his room. The second case was that of a man 
forty years old, who had Ieucoma of one eye from gonorrhoea! ophthalmia. It 
had been variously but vainly treated for a year. The author made incisions 
into the cornea twice, with an interval of fourteen days. After the second, a 
tolerably severe inflammation ensued which required active treatment. As soon 
as it had ceased, sulphate of zinc and tincture of opium were again dropped into 
the eye, and after a year and a half, not a trace of Ieucoma could be seen. — Ibid. 
from Holscher'^s Hannoversche Annalen^ Sept. 1841. 

[Further evidence of the safety as well as efficacy of this plan of treatment 
will be required, before we shall be induced to repose any confidence in it.^ 

57. Local employment of Calomel in Ophthalmia Neonatorum. — A short time 
since. Dr. Kluge began to use calomel as a local application in cases of oph- 
thalmia of new-born infants which came under his care in the lying-in depart- 
ment of the Charite at Berlin. The results were extremely fortunate, and Pr. v. 
Siebold of Goitingeji, who was induced to try the remedy, has obtained from its 
employment very great success. 

The manner of introducing the calomel into the eye is by means of a camel's 
hair pencil loaded with the powder, which is shaken from it into the eye, while 
an assistant separates the lids. In the treatment of the ophthalmia neonatorum 
this remedy may be had recourse to as soon as the first traces of the disease ap- 
pear, and its employment once daily is then in general suflicient. After the 
lapse of from half an hour to two hours, according to the quantity of the secre- 
tion, the eye may be washed from the powder, and the ordinary rules as to 
cleanliness be attended to. In severe cases the application may be re})eate(i 
twice every day; but when the disease is mild a single application daily suffices 
to eflfect a cure in from four to ten days, if the remedy had been had recourse 
to from the outset. The more severe and intractable forms of the disease do not 
appear to have been benefited by the local employment of the calomel. — Ihid. 
from Medicinische Zeitung, June 8, 1842. 


58. Puerperal Fever in Doncaster. — Robert Storrs, Esq., of Doncaster, relates, 
in the Prov. Med. Journ., April 23, 1842, several cases of puerperal fever which 
occurred in his practice during the months of January, February, and March, 
1841, foUow^ed by some interesting remarks on what he considers to be the true 
origin of the disease. " During the whole of the winter of 1840-1," he ob- 
serves, " erysipelas, typhus fever, and scarlatina of a malignant form, prevailed 

1843.] Midivifery, 225 

in Doncaster to an unusual extent, especially erysipelas, which I have never 
before known to be so general or so severe. Puerperal fever was never known 
to have prevailed epidernioally up to this time, or if it did so, it was never ac- 
knowledged. On the night of January 7th, or early on the morning of the 8th, 
the most severe night of the winter, when the thermometer was lower than it 
had been for many years, I attended Mrs. Downes (Case I), a hard-working 
washerwoman, with her tenth child. Her labour was perfectly natural, though 
rather more severe than she was accustomed to, and she had some severe rigors 
previous to delivery, which I ascribed to the severity of the night. On the 
morning of the 9th, thirty hours after delivery, she was seized with another se- 
vere rigor, succeeded by severe abdominal pain, excessively rapid pulse, and all 
the symptoms ascribed to puerperal fever in its severe form. She died on the 
morning of the 12th. 

"On the morning of the 13th, I attended Mrs. Boyd (Case II), of Cautley, 
four miles from Doncaster, an infirm woman. She was seized with severe rigors, 
also, thirty hours after delivery, and died on the 17th. 

"On the same day, January ISth, I attended Mrs. Briggs (Case III), a re- 
markably healthy woman, aged^S, at Doncaster. She remained quite well until 
the I7th, when she also was attacked, and died on the 22d. 

" Mrs. Berry, aged 24, a delicate woman (Case IV), was confined at Doncas- 
ter on the morning of the 24th; the disease commenced on the ^5th, and she 
was dangerously ill for some time, but at length recovered. 

" Mrs. Hird (Case V), also a delicate woman, was confined at Doncaster of 
her fourth child on February 8th. She remained well until the 12th, when the 
usual symptoms set in, though less severely, and on the 17th she was conva- 

"Mrs. Bullas, of High Ellers (Case VI), was confined of her seventh child, 
February 12th. She was attacked on the 14th, and died on the 16th. 

" Mrs. Pearson (Case VII), of Doncaster, was confined, February 19th, of 
her seventh child. She was attended by my friend Mr. Loxley; I called a few 
hours afterwards, and merely spoke to her; she was doing well; when I called 
again, on the 21st, the fever was just commencing, and she died on the 24th. 

"Mrs. Williams (Case VIII), a delicate woman, was attended by me, on 
February 24th, of her fourth child. She was attacked on the 25th, and died on 
the 27th. 

" Besides the above eight cases of fever, I attended sixteen other females 
in labour, from the 8th of January (the day on which I attended the first unfor- 
tunate case) to the 26th of February, all of whom did well; some of them 
within a iew hours of those who took the fever, and in two or three instances I 
went from one to the other. When the first three cases of fever occurred, I 
changed all my clothes, and used every means I could think of to prevent its- 
spread. On the occurrence of another case, I again did so, and after each suc- 
ceeding one, made use of such precautions as extreme anxiety suggested. At 
the same time, I must confess, I had a strong impression that the cause of the 
disease was epidemical, and that my brother practitioners in the town would 
probably also have cases of a similar nature. I now determined to leave home 
for a time, under the hope that, after a change of air, I should be freed from the 
poison, which I could not now but suppose clung to me personally. I left home 
on March 1st, making a tour among my friends, chiefly on the borders of 
Wales, and returned with renewed hopes on the 16th, having again had an en* 
tire change of clothes, and using every precaution (as I thought) with respect to 
ablutions, &c. 

" On the morning of the 2 1st, I again attended a woman in labour, Mrs. Wil- 
son (Case IX), mother of nine children, residing in Marsh-gate, Doncaster. On 
the 22d, at midnight, she was first attacked with the usual symptoms, and died 
on the 25th. On the morning of the 22d, before Mrs. W^ilson was seized, I 
attended Mrs. Bask, of Cleveland-street, Doncaster. She remained quite well 
until the 25th. She was then attacked by the usual symptoms, and died on the 
27ih. Being now led to suspect that some extra puerperal causes produced the 

226 Progress of the Medical Sciences. [Jan. 

mischief, I was confirmed in the suspicion by the opinion of Dr. Thompson, of 
Sheffield, whom I happened to meet in consultation, backed by the experience 
of Mr. Reedall, of the same town, who kindly sent me his opinion through a 
common friend; and the cases which 1 was most inclined to blame I mentioned 
to Dr. Thompson, who confirmed me in the belief that the fever had probably 
sprung from them. This was a case which had been, in the commencement, gan- 
grenous erysipelas of the leg and foot, in a stout, gross woman, a near neigh- 
bour of mine, of the name of Richardson. On looking back at this case, 1 re- 
collected that I had been called to her on the very evening prior to my attending 
Mrs. Downes, the first case, and that the person who was with the latter, as a 
neighbour, was also a neighbour and friend of Mrs. Richardson, and had been 
there also on the same evening. And though this erysipelatous case speedily 
lost its gangrenous character, a succession of abscesses appeared, which every 
now and then required to be opened, some of them containing a large quantity 
of ofl^ensive pus. The last of these abscesses 1 opened on the morning I at- 
tended the last case but one of this melancholy series. It contained an immense 
quantity of foul pus, more than a washhand basinful was evacuated, and even then 
it was far from being emptied. 1 now determijied to cease my attendance alto- 
gether on this case, and the patient was taken off my hands by my friend Dr. 
Branson, who continued to attend her until her recovery was completed, which 
was some months afterwards. I attended on the 22d and 24th three other cases 
of midwifery, having made every possible ablution, and in an entire change of 
clothes; all the patients did well; but considering that it would be too great a 
risk to continue to do so after producing such a great amount of misery, I de- 
termined r would attend no more for a time; I consequently left off the prac- 
tice for about a month, and am happy to say that, since that time, I have had 
but one case to cause rne any uneasiness; I have gone on as successfully, though 
perhaps more anxiously than was my former wont. Besides the decided opinions 
of Dr. Thompson and Mr. Reedall, I am much indebted to my friend Mr. James 
Allen, of York, and to Mr. Smith, of Leeds, for pointing out to me the proba- 
bility of the disease arising from some such cause as the one assigned; though, 
when I saw them, so decided a coincidence as the opening of an immense ab- 
scess, and the commencement of fever in two cases immediately following it, 
had not so strikingly attracted my attention. Having, however, now had my 
attention completely aroused, I found, on reference to my day-book, that on the 
very day or the day previous to having attended in labour, all the cases from the 
4th to the 8th inclusive — except the 7th — I had opened an abscess, or dressed 
the wounds of this erysipelatous case; and though I had taken every pains to 
prevent the conveyance of the contagion from one puerperal case to another, 
yet, having been unaware of the danger of this particular case, I had probably 
carried the fomes from it to every one of them. 

"As a somewhat singular coincidence, or corroboration of this opinion, I was 
requested, some months afterwards, on June 11th, to visit Mrs. Richardson, who 
sent me word that she was nearly well, but wished I would apply a bandage to 
her leg. My mind, however, misgave me, and 1 sent my eldest pupil, Mr. G. 
C. Dunham, to do it on Saturday the 12th. On Sunday he was sent for to the 
Union Workhouse to a labour, where he remained all day: the case was tedious, 
but delivery was at length safely accomplished shortly after my visiting the 
woman that evening. On the Tuesday I called upon her, and found her in the 
first stage of an attack of intense inflammation. She was bled, &c., and after 
a day or two of extreme danger, recovered. Having assured myself, as I think 
satisfactorily, that this case of gangrenous erysipelas and abscess was the origin 
of the mischief, in all the cases but one, I was yet in doubt how that case had 
arisen (No. 7), as I did not attend the case myself; she was attended by my 
friend Mr. Loxley, of the dispensary, and was merely visited by me subse- 
quently. On investigation, I found that her case was also intimately connected 
with erysipelas, which might have been indirectly transmitted through me in the 
following manner: 

" On February 18th, I attended, in labour, a Mrs. Barrett, of Cleaveland-street, 

1843.] Midwifery, 227 

a neighbour of Mrs. Pearson, who did well; but her child was seized with ery- 
sipelas of the abdomen, from the navel to the genitals, of a gangrenous charac- 
ter, and died on February 4th. Mrs. Pearson (Case VII) laid out this child, 
and was confined herself on February 19th, attended by Mr. Loxley; she was 
seized with fever on the 21st, and died on the 24th. Her infant (Mrs. Pearson's) 
was sent out to nurse to a neighbouring village, and was seized with erysipelas 
when a fortnight old, which also assumed a gangrenous character, and the infant 
died on March 27th. 

"Another of the cases of puerperal fever was also incidentally connected with 
erysipelas, viz. Mrs. Briggs (Case VIII). She was delivered, and continued on 
the same bed in which her husband had lain, who had only just recovered from 
a severe attack of erysipelas and typhoid fever. 

"The above cases show not only the probability of the disease having arisen 
from the precise cause above mentioned, but also its intimate connection with 
erysipelas generally. The two cases, however, which occurred so soon after 
my return home, and before I had had any connection with any other erysipela- 
tous case, show, I think, the exact source from whence they sprung. 

" I will now revert to the cases not of a strictly erysipelatous character, which 
seemed to me to have owed their origin to the same disease. Ten days after the 
death of Mrs. Boyd, of Cautley (Case II), I was called to see her mother-in-law 
at the same house, who was seized with intense pleuritic inflammation, with ty- 
phoid symptoms. I saw her on January 27th, and she died on the 29lh, being 
ill only two days; she was upwards of seventy years of age. Mrs. Lockwood, 
of Cautley, waited on Mrs. Boyd and mother; she had also a mild attack of ty- 
phus fever, but recovered. Her son was seized wiih the same disease after the 
mother's recovery, and got better after a tedious illness. 

"Mrs. Mandy, of Nag's-head-yard, Doncaster, a neighbour of Mrs. Briggs 
(Case III), who visited and assisted in nursing the latter, was seized a few days 
after the death of Mrs. Briggs, with severe pleurilis, attended with phlegmonous 
inflammation, and the formation of an abscess on the chest above the right 
mamma, and extensive erysipelatous inflammation down the same side to the 
hip, which has since produced adhesion of the cellular texture to the ribs, and 
absorption of that structure. She recovered very slowly and with great difli- 
culty. A young woman, whilst waiting upon her, was seized with shivering and 
subsequent fever, went home and died in a week, it is said, of typhus fever. I 
did not see her, and only know from hearsay. 

"An unmarried sister of Mrs. Bullas (Case VI) came over to see her, and 
arrived just before her death, on February IGth. She was seized on the 24th 
with severe herpes zoster of a malignant character, the blisters of which con- 
tained blood, or bloody serum, were surrounded with severe erysipelatous inflam- 
mation, followed by considerable sloughing, and attended with typhoid fever. 
Subsequently a large abscess formed in the breast, which was cured March 30th. 
She then soon got well. The sister-in-law of Mrs. Downes, the first case, was 
taken ill of typhus fever a {ev^ days after Mrs. D.'s death, and was in a state 
of considerable danger for some time, but recovered. The whole of these cases, 
whether erysipelatous or not, form a chain of connection with each other. 

"The probability of the identity of erysipelas and puerperal fever has been 
lately stated by Mr. Nunnely, of Leeds, in his work on erysipelas; but unless 
many diseases (such as typhus fever, &c.) are classed under that head, and conse- 
quently very great latitude is given to it, such an opinion must be quite untena- 
ble. It will be observed that many of the cases above related, which arose 
from the miasm of erysipelas or of puerperal fever, produced fevers of an ordi- 
nary or of a typhoid character, according to the condition of the patient at the 
time, influenced also probably by the more or less concentrated state of the 
poison. I am by no means disposed to confine the origin of puerperal fever 
to gangrenous erysipelas alone, though it is my firm belief it arose from it in 
the cases above related, for even in them it was produced from the matter of 
abscesses long after the disease had ceased to be gangrenous. I believe it may 
also readily be propagated from one individual to another, so that if a person 

228 • Progress of the Medical Sciences. [Jan. 

be unfortunate enough to attend a case of the kind, without great precaution, 
he may be liable to transmit it to others, whom he may be attending in the 
puerperal state. In many cases there is good reason to believe that it arises from 
attendance on post mortems, especially where there has been peritoneal inflam- 
mation. A friend of mine told me that be had no doubt but that in his ])rac- 
tice it once arose from his having been called to a labour after the post-mortem 
of a fatal case of strangulated hernia; though in cases of this description there 
are often, probably, circumstances both of an erysipelatous and of a gangrenous 
character. I should also be disposed to believe that it may often be propagated 
by cases of erysipelas without gangrene, especially if accompanied by typhoid 

As to the treatment, Mr. S. observes, "It is plain that where death so con- 
stantly follows every variety of treatment, it can only be of very secondary 
importance to a knowledge of the origin of the disease, and to its consequent 
prevention. With regard to the above cases, they were severally treated ac- 
cording to the strength of the constitution, the inflammatory symptoms present, 
the rapidity of the typhoid, and low symptoms; and the degree of depletion 
was regulated by the consideration of these circumstances. 1 did not find that 
bleeding had any other efl^ect than that of temporarily mitigating the severity of 
the disease; and it will be observed that it was only had recourse to from the 
arm in three cases, and these apparently the most likely to be benefited by 
it. Leeches were always of service in nutigating the pain, and, in one of the 
cases which recovered, were, with the assistance of a blister, the means of sud- 
denly removing the tympanitis, which existed to a great extent. Calomel, 
which was only tried in large doses in the two last cases, seemed to be of es- 
sential service in arresting, and, though very temporarily, suspending the pro- 
gress of the disease, and in each led me to hope for a short time that at last 
1 had discovered a remedy; but its eflfects soon failed, and my disappointment 
has forced me to believe that, in severe cases of this fever, there is no remedial 
means that can be relied on, but that, as surely as the patient is seized with the 
full characteristic symptonns of the disease, she will almost as surely die. All 
the other remedies which were used, I scarcely set any value on. Of turpentine, 
as an internal medicine, I have a very unfavourable opinion; in two cases in 
which it was so employed, it caused intense sickness, and hurried on the sink- 
ing symptoms; as an enema, it was of service in rentioving tympanitis. 

" Opium, at an early stage of the disorder, in a single full dose, is, I think, 
of use; and at an after stage, when the vital powers are flagging, it is of ser- 
vice in smaller doses, where there is much suflTering; but it is by no means the 
same useful remedy it is found to be in ordinary puerperal peritonitis, or in those 
frequent cases of severe spasmodic pain which threaten inflammation. Fomen- 
tations, common or medicated, are always of some service, as are mustard plas- 
ters, and occasionally in mild cases blisters, where you have time; but in most 
of the cases which occurred to me, the period for treatment was so short, that 
any means which required time for their action, were too slow to do good. The 
turpentine fonientation, in having a speedy blistering effect, seemed to be the 
remedy most generally applicable as a counter-irritant. Being in great dread 
of propagating the disease, 1 made no very earnest endeavours to obtain exami- 
nations after death, being satisfied that the subject on this point was already too 
well studied to have any light thrown upon it by my humble means." 

59. Management of Cases of Prolapsus of the Funis. — The following are Pro- 
fessor Osiander's, of Gottingen, conclusions relative to this subject. 

" 1. Manual intervention is not required in every case of prolapse of the funis 
beyond the os uteri. It very frequently happens that the head passes beyond 
the funis, and that labour is terminated without any accident, though the case 
is left entirely to nature. 

" 2. When the conditions are favourable, that is to say when the child is of 
moderate size, when the structure of the parts is natural, and the pains are effec- 
tive, it is best to leave the case entirely to nature. Moderate pressure on the 

1843.] Midwifery. 229 

cord is seldom dangerous in these cases any more than when the funis is twisted 
round the child. At the most, if the process of labour is slow it may be proper 
to apply the forceps. 

*' 3. Turning^ should not be resorted to unless some other circumstance than 
the prolapse of the cord renders it necessary. The old maxim that in all cases 
of funis presentation the child is to be turned is as ill-founded as it is mis- 

" 4. Cessation of pulsation in the cord is not a certain sign of the death of the 
fcetus, and is rather an indication for hastening delivery than a reason for ne- 
glecting the condition of the child. 

"5. Attempts to replace the prolapsed funis within the uterus are seldom in- 
dicated; but on the contrary are almost always fruitless, while they are likely 
to interrupt and arrest the process of labour. If, however, the funis is low down 
in the vagina, or has descended out of it, it must be replaced, and retained 
within it by a sponge, a compress, or other means, since the action of the cold 
air speedily interrupts th^ circulation in the cord and occasions the death of the 
foetus. — British and Foreign Medical Review^ Oct. 1842, from Neue Zeitschrift fiir 
Gehuriskunde. Band xii. Heft i. 

60. Extraordinary Case of Twins. — Dr. Jamieson, of Dublin, relates the fol- 
lowing case in the Dublin Journal of Medical Science., for September, 1841. 

On the 3d of April, 1841, he was called to visit a lady 30 years of age, in 
consequence of severe pain in the abdomen, recurring at uncertain intervals, and 
lasting generally about five minutes at a time. 

The author discovered a firm hard tumour, reaching as high as the umbilicus, 
which softened on the sui)sidence of pain, and appeared to be the gravid uterus. 
On applying the stethoscope. Dr. Jamieson thought he heard a placental mur- 
mur in the right iliac fossa; but the lady said it was impossible she could be 
with child, as she had been confined so recently (seven weeks before), and was 
at present nursing. As, however. Dr. Jamieson was convinced that the tunjour 
was the uterus, and that it was acting to get rid of something, he ordered a dose 
of oil and retired to another room, in order to explain to the husband that he be- 
lieved there was some foreign body in the uterus of his wife. 

The author was hurriedly summoned, while engaged in this explanation, to 
the apartment of the lady: and on examining per vaginam, found the head of a 
small child presenting, with the membranes entire, which, on the occurrence of 
another pain, was expelled together with the placenta. The child was dead, 
and seemed to be about the sixth month of gestation; and though shrivelled and 
dark, was not at all putrid or decomposed. It was between eight and nine 
inches long. The mother was of course greatly surprised. She had been con- 
fined of the other twin on the 13th of February. Consequently the dead fcetus 
must have remained in the womb for forty-nine weeks. 

61. Short Funis. — Dr. J. R.Thomson relates in the Lancet^ June 4, 1842, 
a case in which the funis was only seven and a half inches long. 

Mr. Stone has met with a case in which the funis was still shorter, being 
only six inches; and Mr. Wm. Collyns, {Provincial Medical Journal^ Aug. 6,, 
1842,) another, in which the funis was scarcely that length. 

62. JInte-version of the Uterus, reduced bi/ position alone. By Db. Godefroy, 
Professor of Midwifery in the Medical School of Rennes. — Madame F., mother 
of two children, and having a large pelvis, was seized in August, 1839, while in 
the fourth month of pregnancy, with a sense of weight and dragging sensation 
in the groins and pelvis, and a constant desire to void her urine. When she 
was seen by Dr. G., the mucous membrane of the vagina was protruded beyond 
the vulva, from the strong efforts that she was making to empty the bladder. A 
catheter was introduced, which drew off about a wine-glassful of urine. Upon 
practising the toucher, the neck of the uterus was found situated upwards and 
backwards, and below the sacro-vertebral angle; in front, a round tumour was 

230 Progress of the Medical Sciences. [Jan. 

felt pressing upon the pubis. The patient having been placed as for a case of 
laborious labour, the uterus was restored to its natural position by introducing 
one fore-finger into the vagina and the other into the rectum. In the following 
year, at the same period of pregnancy, she was seized with similar symptoms 
to those described above. Dr. G. not being able to attend upon her immediately, 
he recommended her to be placed in a position, which, in all probability, would 
relieve, if not effectually cure her. He advised her to be put on ihe side of the 
bed, with her head and hands on the floor, and with only the anterior part of the 
thighs and legs resting on the bed. He says, that in this position the intestines 
are drawn towards the diaphragm; that the pelvis is consequently emptied, and 
the uterus, being no longer pressed upon, resumes its normal situation. And 
this is what happened to the lady in question. She had scarcely been fifteen 
minutes in the above posture, when all painful sensations subsided. She then 
went 10 bed, where she was when Dr. Godefroy saw her, two hours after her 
attack. At this time she only complained of a feeling of weariness in the pelvis, 
with heat of the external parts. He did not practise the toucher. Being so 
delighted with the result of this case, he determined to try the effect of the same 
position in the next case that he saw, which was not till October, 1841. Case 
2. — Madame C, between three and a half and four months pregnant of her first 
child, 33 years, and well formed, was seized, on the 27th October, 1841, with a 
feeling of weight in the pelvis, and with frequent calls to make water. She 
went to bed, but did nothing else. She was able to get up next day. Dr. 
Godefroy was sent for on the morning of the 29th, as she thought she was going 
to have a miscarriage. He found similar symptoms to those already detailed in 
the first case. Upon examining her by the toucher, the neck of the uterus was 
felt behind and towards the curvature of the sacrum, while the fundus was in 
front and behind the pubis. As the bladder did not appear full, the catheter was 
not introduced. The patient was placed in the position recommended, viz., her 
head and hands on the floor; with the front part of the thighs and legs resting 
on the bed. Dr. G. was witness of the progressive improvement observed in 
this lady; at first the feeling of weight in the pelvis diminished, and then the 
desire to void urine ceased. As the position was very fatiguing, she was sup- 
ported by the shoulders. She was kept for twenty minutes in this posture. 
Upon her lying down again in bed the uterus was felt by the toucher to be in 
the natural position. He is anxious that his medical brethren should adopt the 
same mode of treatment in similar cases, until it can be seen whether a more ex- 
tended trial will sanction its employment. — L. ^ E. Month. Jour. Med. Sci.f 
March, from Annales d* Ohst. ^c. Jan. 1842. 

G3. Stony Placenta. — A singular case is recorded by Madame Buisson Dau- 
THEZ, a midwife, at Paris, under this title. Her patient was delivered in Feb- 
ruary last of a living female child, which did well. The delivery was somewhat 
retarded by the size and consistence of the placenta. It was the patient's third 

The placenta was perfectly round; the cord was attached to its centre, and 
the membranes could be readily separated as far as the root of the cord. The 
diameter was seven inches in every direction, and it was an inch thick in the 
centre. The vessels, instead of ramifying, as in ordinary cases, terminated in 
two distinct sinuses for the two orders of vessels. The fcetal surface did not 
present any remarkable appearance, but on that which had adhered to the uterus 
were remarked distinct lobes, formed by a concrete matter which resisted the 
scalpel; the colour and consistence being that of gray plaster. In order to 
ascertain how far the spongy substance was filled with this composition, the 
placenta was washed, and it was ascertained to be formed entirely by distinct 
concretions, larger at the edges than at the centre, but sufficiently free to allow 
of their separaiion. The accomplishment of the delivery without very great 
difficulty was owing to this mobility of the concrete lobules. 

The patient had not experienced any of the strange whims which infect preg- 

1843.] Medical Jurisprudence and Toxicology. 231 

nant women, nor had she suffered from gout, rheumatism, or disease of the 
heart. — Frov. Med. Jour. Oct. 1, 1842, from Gaz. Med. de Paris, July, 1842. 


64. Marriage of the Beaf and Dumb. — A curious case of opposition to the mar- 
riage of a deaf and dumb girl has just been decided by the supreme tribunal at 
Berne. It appeared, that Anne Luthi, the person in question, an exceedingly 
pretty young woman, of twenty-five, and possessing a fortune of 30,000 francs, 
had been placed in a deaf and dumb institution near Berne, where she had re- 
ceived an excellent education. On her return home to Rohrbach, her hand was 
demanded by a M. Brossard, who had been deaf from fourteen years of age, 
and had been employed for some years as a teacher, in the institution. He was 
thirty-two years of age, bore an excellent character, and had saved some money 
out of his salary. As Art. 31 of the civil code of Berne enacts, that deaf and 
dumb persons could not marry without having first obtained permission from the 
tribunal, Mdlle. Luthi made application in the usual manner, but was opposed 
by her relations and by the commune in which she lived. The grounds of oppo- 
sition were, that Brossard had taken an undue advantage of his position, in the 
institution, to captivate the young girl's affections — that it was to be feared that 
the children would labour under the infirmity of the parents — and that the latter 
could npt, in case they were like other children, give them the cares required for 
a good i*noral education. The objections relating to the children being proved, 
by the testimony of medical men, to be perfectly chimerical, and letters being 
produced from the female herself, admirably written, breathing the utmost affec- 
tion for Brossard, the court decided that as from their infirmity being mutual, 
and their consequent habit of interchanging ideas by signs, they were well suit- 
ed to each other, and there were good grounds for expecting that the female 
would be happier with Brossard, than with any other person, no just grounds 
for opposition existed, and permission must accordingly be given for the mar- 
riage. — Athenaeum, July 30, 1842. 

65. Poisoning by Muriatic Acid. — As cases of poisoning by this acid are compa- 
ratively rare, the following from Mr. Herrship's work on affections of the stomach, 
may be here stated. A young man, in a fit of depression, swallowed half a tea- 
cupful of a solution of tin in muriatic acid. In five hours, I found him in se- 
vere pain at the stomach, with restless anxiety, thirst, and copious vomiting of 
stiff glairy mucus. Pulse 100, very small, rather hard. A full bleeding was 
taken from the arm, and oily diluents freely given. Dr. Hooper directed a blis- 
ter to the stomach, aperient medicines and an emollient enema. The next day, 
the medicines had operated, but the symptoms were worse. Dreadful pain at 
the stomach, restlessness, astonishing quantity of mucus rejected, quickness and 
lowness of pulse all greatly aggravated. On the third day, the rapid pulse was 
scarcely perceptible, the other symptoms continuing, in the evening delirious, 
and in the night he died. Post Mortem. 1 found the mucous lining of the oeso- 
phagus somewhat inflamed. The stomach externally violently inflamed, internally 
thickened and pulpy, was excessively vascular, and filled with a stiff ropy 
mucus. A few inches only of the duodenum also were inflamed, yet no spas- 
modic contraction was observed.— Qt^o/ec? in Medical Times, October 9, 1841. 

&Q,. Asphyxia.—Dx. Richardson detailed a case at the meeting of the British 
Association, at Manchester, which is interesting from its cause and history. It 
occurred in the operations for clearing the deck of the Royal Georoe. The 
divers are equipped with a water-proof'dreas of Macintosh fabric, with'^a metal- 
lic helmet resting on the shoulders, to which is attached a tube, through which 
air is forcibly pumped from above. The divers generally remain below from 
half an hour to an hour or more, without any inconvenience, and return with 

232 Progress of the Medical Sciences, [Jan. 

their inner dress of flannel perfectly dry. On the 4th of October, 1841, while 
Roderick Cameron was below, the air tube burst near the pump; he was instantly 
hauled up by the safety line attached to him; the first disagreeble sensation he 
experienced was an unusual pressure of the helmet and leads against the collar 
bone and chest, followed by an urgent feeling of suffocation, after which he 
speedily lost all sensation; he was drawn up in a little more than one minute; 
and a few seconds elapsed before the helmet was removed. He remained lying 
on the vessel's deck, on board which he was drawn, for about a quarter of an 
hour, when he showed signs of consciousness, and was able to speak; in about 
an hour he was received into Haslar Hospital. The pain in the head, dimness 
of sight, soreness of throat, and other effects of the accident disappeared in four 
or five days. — Mhenseum, July 30, 1842. 

The Medico-Chirurgical Review, for October, 1842, adds some additional in- 
formation concerning this interesting case. A little blood only escaped from his 
nose and none from his ears and mouth. His head, neck and eyes, were how- 
ever ecchymosed, and this continued for several weeks. "At the expiration of 
a month, the ecchymoses under the conjunctivae, which remained the longest, 
has disappeared, and undaunted by the perilous accident which had jeopardized 
his life, he returned to his work as a diver, which occupation he still fearlessly 

Mr. Liddell, the author of the above communication, gives the particulars of 
a similar and later case: 

.John Williams, aged 26, of great strength and activity, but addicted to habits 
of intemperance, had been employed for two summers on the wreck of the Royal 
George as a diver, and is considered one of the most expert workmen. On the 
morning of the llih of July, 1842, while clothed in, his submarine armour, he 
was engaged at the bottom of the sea, at the depth of eighty feet from its sur- 
face, in fastening an iron chain round a block of wood that was imbedded in the 
stiff mud; which task, after an hour's labour, he had just completed, when the 
flexible tube that supplied him with air, suddenly burst above water, with a loud 
hissing noise, which was distinctly heard at the distance of fifty fathoms. The 
persons stationed at the air tube immediately perceived the accident that had 
happened, and one of them closed the hole in the tube with his hand. Williams 
was promptly hauled up, but his armour got entangled in the heavy rope ladder, 
by which the divers descend, and he and it were pulled up together, in the space 
of about a minute and a half, from the occurrence of the accident. 

On removing the helmet from his head, blood was seen running in a stream 
from his ears, nose and mouth. His face and neck were swollen and discolour- 
ed; he looked faint, but was sensible. In this state he was conveyed to the hos- 
pital, where he arrived in an hour after the accident. His face then was one 
mass of lividity, his neck was excessively swollen, bloated, and suffused with 
livid coloured blood. Dark patches of ecchymosis that did not coalesce existed 
over the clavicle and shoulders, with intervening spaces of skin of the natural 
colour. The lower part of the neck, which had been covered with the flannel 
and India rubber dress, was mottled black and white; the dark ecchymosis being 
raised in lines, with slight streaks of white skin interposed. The livid discolo- 
ration of the face extended upwards to, but did not pervade the hairy scalp, 
where it terminated abruptly, nor were any spots seen below that part of the 
chest which was covered with the helmet. The lining membrane of the cheeks, 
under the tongue, over the fauces and pharynx, as far as the eye could reach, but 
especially over the tonsils, was black with ecchymosis. The conjunctivae, where 
they are uncovered by the eyelids, and particularly round the margin of the cor- 
neas, were turgid with black blood. He vomited some blood before he reached 
the hospital and he afterwards made occasional efforts to vomit, apparently from 
the accumulation of blood in the fauces, which blood, he now and then expecto- 
rated. The hemorrhage had ceased from the nose and ears, which were still 
covered with clotted blood. He was perfectly sensible, but seemed drowsy; 
pulse 76, of natural strength; breathing interrupted by frequent deep and invo- 
luntary sighs. 

1843. J JMedical Jurisprudence and Toxicobgy, 233 

Lieut. Hutchinson, who was present when the accident happened, and who 
accompanied Williams to the hospital, said that the swelling- of the face and 
neck had much increased, and the lividity had miich deepened, during the hour 
that had elapsed since he left the hulk. 

In the course of the same day, the lividity of the nose and point of the chin 
vanished, and those parts resumed their natural colour. The colour of the face 
too became much paler, in proportion as the vessels recovered their freedom and 
diameter; but there were laro^e patches of extravasated blood in the eyes, mouth, 
face and neck, which could only be removed by the tedious process of absorp- 
tion. On his admission, warmth was applied to his extremities; some warm tea 
was given him, which he sv/allowed with the greatest difficulty; he had a tur- 
pentine enema, and in the co\irse of the day, twenty ounces of blood were taken 
from his arm. The following morning a senna draught was prescribed. He 
has complained of occasional headache and dimness of sight, but of this, at the 
date of the report (August 8) he was now free. The swelling and ecchymosis 
of the face and neck have daily diminished, and these parts have now attained, 
their natural size and colour, showing that they were swollen, on his admission, 
to twice their natural size. The ecchymosis under the conjunctivae were very 
tardily absorbed, and minute clots were visible for three weeks around the union 
of the cornea and sclerotic coat. 

Mr. Liddell refers to a third case, similar to the above, of a diver at the wreck 
of the frigate Thetis, in South America. Here too, the air tube burst, and the 
individual became entangled with the bell, so that there was some delay in bring- 
ing him to the surface. When he reached it, his face and body were blackened 
with ecchymosis down to the waist. This discoloration gradually went off in 
the course of a month, the blackness of the balls of the eyes being the last to 

These curious and strikingly similar effects are supposed by Mr. Liddell to 
arise from the sudden removal of the compressed air, and the consequent exer- 
tion of the pressure of the superincumbent water on those parts of the body 
which are not covered by the unyielding helmet. In the case of Williams, this 
pressure at the moment of the accident, is supposed to have been nearly equal to 
the weight of three atmospheres, and which was counteracted and the equili- 
brium preserved, by throwing air through a forcing pump of great power, alontr 
a flexible tube into his helmet. When the tube burst, the equilibrium was de- 
stroyed. The head was protected by the strong helmet, and did not collapse 
from the pressure of the circumambient water, which now acted on the rest of 
the body, with a force equal to two atmospheres, and produced a feeling, as he 
expressed it, as if he had been crushed to pieces by his dress. The blood thus 
driven from the extremities and from those parts of the body that were not 
covered by the helmet, was forced into the vessels of the head and neck, (as it 
is into a part of the skin placed under a cupping glass) some of which blood 
remained in the vessels and disappeared in a few hours after the accident, but a 
large portion was extravasated in the loose textures in which it had been forcibly 

67. Action nf Chlorides upon Proiockloride of Mercury (Calomel.) By M. Mialhe. 
(From the Annales de Chimie et de Physique, June 1842.) The following ex- 
periments have an intimate bearing on one of the most interesting subjects in 
legal medicine, viz: the chemical changes induced in the principal mercurial 
preparations, when they are taken internally. It is evident, also, that their 
administration as medicines must be modified by the facts ascertained. 

M. Mialhe remarks that Capelle in 1763 first observed the danger arising from 
a mixture of calomol and sal ammoniac; Proust afterwards proved^ the conversion 
of calomel into corrosive sublimate by the action of the alkaline chlorides. 
After mentioning other authors, M. Mialhe refers to a note of his own, contained 
in the Journal de Pharmacie for February, 1 840, in which he details experiments, 
proving first, that calomel acted upon by the alkaline chlorides always yields 
more or less corrosive sublimate. Second, that it is to this partial conversion 

234 Progress of the Medical Sciences. [Jan. 

that calomel owes its medicinal powers, and he afterwards mentions different 
authors who have confirmed his opinions. 

He then relates various experiments which he has since performed, to deter- 
mine the proportion of corrosive sublimate, resulting under certain conditions 
from this action: 1. 1000 parts of distilled water, 60 of common salt, 60 of sal 
ammoniac and 60 of calomel (prepared by sublimation) which had been per- 
fectly washed, were mixed and allowed to react for twenty-four hours, the tem- 
perature varyinof from 68° to 77° Fahrenheit; there was produced 0.6 of a part 
of corrosive sublimate. Similar experiments were made with calomel, prepared 
by precipitatia, with precisely similar results. 2. 1000 parts of the assay liquor 
(the alkaline chlorides just enumerated,) had 60 parts of calomel, (a la vapeur,) 
dig^ested in it for 24 hours, at a temperature varying- from 104 to 128 Fahr., and 
1.5 of corrosive sublimate was produced. When precipitated calomel was sub- 
stituted, a mean was yielded of 1.7 of corrosive sublimate. "This chemical 
result confirms the opinion of therapeutists, who have always considered the 
calomel obtained by precipitation, as sensibly more active than that prepared in 
the dry way." 

M. Mialhe subjoins the results of numerous other experiments on points con- 
nected with this investigation. It will be sufficient in this place, to mention his 
influences, as supported by these. 1. The quantity of sublimate produced is 
proportional not to that of the calomel employed, but to that of the alkaline 
chlorides. The amount of sublimate obtained does not increase, with the in- 
creased quantity of calomel that is added, but actually does so, if a large propor- 
tion of the alkaline chlorides be employed. 2. The degree of dilution of the 
alkaline chlorides has a decided influence on the quantity of sublimate produced. 
3. It was proved by direct experiments, that the presence of neutral organic 
bodies does not hinder the conversion of calomel into corrosive sublimate; on the 
contrary, dextrine favours the change, sugar and albumen probably do not 
modify it, and lastly, lard and gum arable very evidently retard it. 4. The pre- 
sence or absence of air modifies the results. When air is present, calomel and 
the alkaline chlorides produce three times as much sublimate as when they re- 
act without it. 5. Calomel may be very partially converted into sublimate by 
the influence of boiling distilled water deprived of air: 1000 parts of boiling dis- 
tilled water and 60 parts of calomel, were kept at 212° for an hour. After cool- 
ing, the water was found to contain 0.1 part of sublimate. — London^ Edinburgh 
and Dublin Philosophical Magazine, October, 1842. 

68. On Pulmonary Emphysema, as a cause of death. T3y Dr. Prus. — The 
following is a report on this memoir, read before the Royal Academy of Medi- 
cine, of Paris, in May, 1842, by Messrs. Husson, Boaillaud, Adelon, and 

Dr. Prus commences by remarking that Laennec has indicated pulmonary 
emphysema, as one of those diseases which require further investigation. Pie- 
dagnel, Leroy D'Etiolles, Louis and Stokes have responded to the appeal. Two 
of the conclusions of Louis, are in his opinion, irrefragable, viz. 1. That pul- 
monary emphysema when once established, advances and developes itself slowly 
in some cases, and rapidly in others. 2. That the extent of this disease is 
generally in proportion to its duration. 

Still the subject is far from being exhausted, and on the point which he par- 
ticularly notices, the following diversity of opinion exists. Laennec and Louis 
declare distinctly, that pulmonary emphysema is never mortal; Magendie, 
Breschet, Piedagnel, Leroy D'Etiolles, Ollivier D'Argers, Devergie, and Boi- 
vier, are of a contrary belief. 

Facts alone can determine this difference. We already possess numerous 
cases showing that the disease may exist for a greater or less length of time, 
without rapidly abridging the duration of life. But these negative facts cannot 
put aside the positive instances, which prove that death more or less rapid may 
ensue from this form of emphysema. It is true, that these are few in number, 
and restricted probably to a case of Magendie, published by Breschet in the 

1843.] Medical Jurisprudence and Toxicology. 235 

Dictionnaire des Sciences Medicaks, and another by Ollivier D'Angers. Mr. Prus 
lias, in addition to these, observed no less than eight cases at the Bicetre and 
Salpetriere, and which ought to exercise a decided influence in resolving a ques- 
tion important in pathology, hut still more so in legal medicine. 

If pulmonary emphysema, whatever be its degree of development, or the 
rapidity with which it has advanced, cannot cause death, then medico-legal ob- 
servers should so understand it, and not attribute to the disease effects which it 
cannot produce; but if the contrary be the fact, then its presence in a medico- 
legal dissection should be carefully noted, and dwelt upon, lest peradventure, 
we ascribe to a crime, the natural effects of a disease as yet imperfectly un- 

M. Prus adduces the following as illustrative of the necessity of more settled 
views on this subject. An individual was found dead on the highway. The 
physician charged with the examination of the body, could discover no lesion, 
except a considerable pulmonary emphysema. Being unwilling to decide on 
this himself, and not finding any assistance in works on legal medicine, he ad- 
dressed a friend in Paris, to inquire whether the point had been adjudicated by 
medical inquirers. The answer was in the negative. 

M. Prus expresses the hope that the facts adduced by him will aid in deter- 
mining the truth. Previous to stating these, he deems it necessary to settle the 
true seat of the disease. Laennec and Louis allow of two species; the one the 
most frequent consisting in a dilatation of the vesicles; the other uncommon, 
and in which the air has passed into the interlobular and subpleural cellular 
tissue. Our author is of opinion, that the name should be confined to the latter 
of these, and that the presence of air in the intervesicular, interlobular and sub- 
pleural cellular tissue, constitutes three degrees of the same disease. The dilata- 
tion of the pulmonary vesicles, if it does occur, is certainly much more rare and 
indeed much less considerable, than has been said and repeated, without suffi- 
cient examination, since the investigations of Laennec. 

To this succeeds the narrative often cases, which, however, according to the 
reporters, were too long to be read in detail before the Academy. Along with 
these he gives a full sketch of the symptoms and appearances on dissection, 
noticed by him in those to whom the emphysema proved fatal. It is to be re- 
gretted that these are not stated in detail. Some of his inferences are, however, 

Asthma, properly so called, he considers to be distinct from pulmonary em- 
physema. The latter may occur altogether independent of the former, although 
it is frequently the consequence of asthma. 

The blood in persons who die of emphysema has peculiar characters. It is 
always fluid, blackish, and oily; and in these respects, corresponds with the 
blood of those who die asphyxiated. 

M. Prus also quotes Floyer and Dupuy, to prove that the emphysema often 
noticed in broken-winded horses, is similar to the disease in man. 

He concludes his memoir by discussing the observations made by Morgagni, 
Ruysch, Van Swieten, Floyer, and Storck, on pulmonary emphysema; and 
shows that the three last had a perfect knowledge of its seat and its danger. 
Storck in particular, recognises a phthisis seu consumpHo aerea. 

This phthisis is characterised by an incessant difficulty of breathing; by the 
thorax being arched at the part corresponding to the emphysema; by the exces- 
sive sonorousness of this part, and the diminution of the respiratory noise in the 
subjacent portion of the lungs; by frequent threatenings of instant suffocation, 
accompanied vviih blueness of the face and extremities, and finally, by asphyxia 
and death. On dissection, the intervesicular, interlobular and subpleural cellular 
tissue is found so distended with air, as to prevent the circulation of the blood. 
Sometimes also, true air cavities (cavernes) are seen, either on the surface of the 
lungs, or in their interior. The blood is every where liquid, blackish, and oily. 

The principal conclusions of the memoir of M. Prus, are the following: 1. 
The seat of the disease. The peculiar views of the author on this, have been 
already stated. 2. Pulmonary emphysema may be a lingering disease, and thus 

236 Progress of the Medical Sciences. [Jan. 

give sufficient indications of its fatal termination. 3. It may cause death rapidly, 
and indeed suddenly. And it is in instances of the last description, that the in- 
vestigations of the medico-legal examiner are particularly demanded. — Bulletin 
de P Mademie Royale de Mcdecine de Paris., May 24, 1842. 

69. On Pulmonary Emphysema as an Jlnatomical prnnf nf death by Asphyxia, 
By Alph. Devehgie. — The recent and interesting notices of Dr. Pros, on this 
disease, have recalled to our recollection the above communication of Devergie, 
which was published in April, 1841. 

Our author commences, by stating, that in the drowned, who die from as- 
phyxia, the lungs are observed to be greatly distended, and seem as if com- 
pressed together in the cavity of the chest. On opening it, they instantly expand. 
Sometimes they are so much developed, that after dividing the anterior medias- 
tinum, their edges lap over each other. 

For a long time the cause of this phenomenon was supposed to be putrefac- 
tion, but an attentive examination of the pulmonary tissue in the drowned and 
asphyxiated, during every season of the year, and particularly in winter, has 
convinced him that itshould be ascribed to pulmonary emphysema. If we care- 
fully notice, in such cases, the tissue of the lungs, we shall see all the cells 
enormously distended, and communicating with each other. This induces crepi- 
tation — a phenomenon unknown in the healthy state. A gentle pressure on 
these projecting points will readily dislodge the contained air, and the parts then 
resume their natural appearance. 

1 consider (says Devergie,) that pulmonary emphysema occurs more fre- 
quently than is generally supposed, and am convinced, that even a slight obsta- 
cle to the exercise of respiration, may induce it. It manifests itself during the 
struggles that attend the last moments of the asphyxiated, whether from drown- 
ing or from carbonic acid, or pulmonary congestion, or indeed any cause of death 
that is capable of impeding the breathing. It is produced during the last in- 
spiratory efforts, or in the agonies which attend the expulsion of water from the 
trachea of the drowning. 

1 do not assert that this always attends death from emphyxia, 1 only say that 
it very frequently accompanies, and hence when present, is a striking proof of 
the kind of death. And the frequency of its occurrence first led me to doubt its 
being a cadaveric phenomenon. In two recent cases, MM. Jadelet, and Roger, 
(de L'Orne,) have also noticed it. One was in a female aged 47 years, who, 
after a hearty supper with her paramour, and a gay evening, retired to bed with 
him. She was seized, during coition, with a sensation of suffocation, leaped 
from the bed, and after violent agony, soon died. On dissection, there was found 
a serous congestion of the pulmonary tissue with general emphysema, and froth 
in the bronchiae and trachea. This female had never laboured under short 
breathing, on the contrary, she was very lively and alniost always singing. 

The second was a very different subject. A man of 40 years of age, addicted 
to liquor, was knocked down by a loaded cart; one of the wheels passed ob- 
liquely over the left thigh, and then crushed the calf of the right side. The femur 
was fractured, and the muscles of the leg and thigh torn, but the chest was not 
injured. Yet on opening the body, there was pulmonary congestion, with 
general emphysema; the pleura, particularly at the case of the lungs, was raised 
by bubbles of air, forming numerous swellings. Here then, are two instances, 
in which either spasm, from high excitement or pain, induced the development 
of this disease. 

Andral, Ollivier, Piedagnel, and Pillore, have mentioned similar instances. 

Still, physicians engaged in a medico-legal examination, should recollect that 
putrefaction inay also induce it. — Innales D'' Hy giene. T. R. B. 

70. Death by Strangulation., and an attempt to conceal the crime by burning the 
body? — I have, in my work on Medical Jurisprudence, referred to several cases 
resembling the one now to be stated, but the truths which they inculcate will 
bear frequent repetition. 

1843.] Medical Jurisprudence and Toxicology. 237 

Moral Circumstances. At the Yorkshire Assizes, in Eng^land, in March, 1842, 
Jonathan Taylor was tried for the murder of his wife. He had lived on a farm 
of Lord Wenlock; but four years previous, he formed an illicit connection, and 
left his wife, and the farm was made over by his landlord to his family. He 
ultimately returned at times, and was, on such occasions, employed in day la- 
bour on the farm. On Tuesday, October 26th, all the family left home at nine 
o'clock to go to work, but the wife. Early on that morning-, the husband had 
also left, saying that he was going to Selby. At twelve o'clock, two of the 
daughters returned home, and then found the wife quite dead, lying upon the 
hearth near the fire, upon her face, and apparently in a burning state, her clothes 
being on fire, and the lower part of her person very considerably burnt. A bunch 
of keys was found lying under her. Medical men were sent for, and an exami- 
nation was made, the details of which will be presently given. The deceased 
had been seen to go to a drawer at eight o'clock that morning, to look at some 
silver (about ^3,) which she had kept there. She was seen to lock it, and the 
drawer was found locked; but the money was gone. Lord Wenlock's agree- 
ment with the family, and a policy of insurance on the stock were also missing. 
The keys, therefore, which were found lying under her, must have been used to 
procure the money at least, and it was remarked, that notwithstanding the fire, 
they were perfectly bright. The husband had also been accidentally spoken to by 
a miller in the house, at half-past nine that morning. It was proved that he 
reached Selby at half-past eleven. 

Post mortem Examination. Mr. Anderson found the following appearances, 
about twenty-nine hours after death. The whole of the head and face extending 
down below the thyroid cartilage of the neck, was much swollen, and of a pur- 
ple hue, including the ears; the eyes full, prominent and bloodshot; the mouth 
closed. Immediately below the swollen part of the neck, there were two dark 
brown, crackly and hard marks across the front part of the neck, and extending 
from these (to the left side especially, and more indistinctly to the right,) were 
slight indentations formed by pressure. The integuments of the head, particu- 
larly of the occiput, were swollen and distended. 

The burns extended from the region of the liver on the right side, obliquely 
downward across the abdomen, to the left side, which was less injured. They 
extended some way down the left thigh, and down the right leg to the knee. 
Both hands were partially closed; the right hand was severely burnt; and the 
ends of the fingers with loss of substance and black. There were no material 
burns below the knee. There were some very slight burns on the back part of 
the ri^ht shoulder: there were no vesications containing liquid •&% or near any of 
the burns, and no swelling or inflammation on the edges of the burns. 

On cutting into the scalp, which was divided from ear to ear, a large quantity 
of dark, fluid, and very thin blood flowed copiously away, and the scalp was 
much darker and more injected than natural. The portion corresponding to the 
external swelling was much thickened and injected, with small coagula in its 
substance, and there was some fluid blood between the scalp and the skull. On 
sawing through the skull, the blood flowed still more copiously. When the 
dura mater was separated from the skull, numerous points of blood issued from 
each. The brain also was highly injected. 

Medical Opinions. The thickened, injected, and swollen part of the scalp on 
the back of the head, and its separation from the skull, indicated violence dur- 
ing life. This might probably have caused insensibility, but not death. The 
horizontal marks on the neck, with the external appearances, and those found on 
dissection, denote strangulation. It was found on cutting into the dark, brown, 
and crackly and hard marks on the neck, that several small blood-vessels were 
infiammatorily injected, and it is suggested that a hot substance may have been 
passed over these horizontal marks after death, in order to conceal them, and 
that thus their peculiar condition might be accounted for. 

The nature of the burns, and all their attendant circumstances, seem to prove 
that the body had not moved during the process, and consequently that death, 
must have preceded it. 

No. IX.—January, 1843. 16 

238 Progress of the Medical Sciences, [Jan. 

The jury, without leaving their seats, found the prisoner guilty. 

Although the above report is not drawn up in the most satisfactory manner, 
and might have been readily improved by a more familiar acquaintance with 
modern observations on the controverted points, yet the testimony appears to me 
to justify the verdict — Lancet, April 23, 1842. T. R. B. 

71. Presumption of Survivorship. — 1 am indebted to a friend for the following 
translation of Dr. Krugelstein's Essay on the above subject, contained in Wild- 
bertr^s Jahrhuch der Gesammten Slaatsarzneikunde, T. R. B. 

The cases in which the presumption of survivorship may arise, are the follow- 
ing. 1. When mother and child both die during delivery. 2. When many 
persons perish at the same time, as under the ruins of a falling building, or io 
a sandpit, or by an earthquake, or by the fumes of charcoal; or when many per- 
ish at the same time by shipwreck, or in drowning, when hurled together into 
an abyss; destroyed in a conflagration; simultaneously poisoned; dying at the 
same time from wounds; from hunger or from cold. 

A. On the presumption of survivorship, when the mother and child die during 
delivery, two cases may arise. 1. The mother dies during delivery, without 
bringing forth the child. Here there may be a legal question, whether the right 
of inheritance of the child, though living, but not born, could be transferred to 
a third person. 

2. The mother dies during delivery, and after her death, the child is born and 
found dead, no one having noticed its delivery. 

In the first instance, it must be previously ascertained what was the cause of 
the death of the mother, and what the presentation of the child. If the latter is 
natural, and the parts exhibit mechanical impediments to delivery, and the 
mother died suddenly of a nervous affection, then the presumption is in favour 
of the child surviving. Opposed to this, in the opinion of Jorg, is the case 
cited by him, of a robust and remarkably healthy peasant woman, who for seve- 
ral weeks previous to the full time, suffered under eclampsia gravidarum, and 
during one of these convulsions, without its being noticed by any one, brought 
forth a dead child, with the placenta. He remarks, however, that eclampsia 
usually attacks only healthy, muscular, and especially full-blooded women; and 
that the probability of the death of the fcetus, either before or during delivery, 
is increased according to the length of time that the mother has been suffering 
under the disease. 

But if the position of the child be unnatural, and especially if the funis has 
protruded, we may assume (and above all, if the pains have been violent,]^ that 
the mother died after the child. 

In the case of a child full grown, and capable of living, born after the death 
of the mother, the proof by examining the lungs is conclusive as to its life. But 
if we find on it no signs of maturity, or of intra-uterine life, the presumption is 
in favour of the niother surviving, and particularly if there be marks of putrefac- 
tion in the fcetus. 

B. When many persons are destroyed at the same time, the first inquiry is 
as to the cause of death, whether by suffocation, hunger, thirst, or wounds. 

In c-^ses of suffocation, we must notice the age, condition of body, sex, and 
the position of the dead. In reference to age, children and young persons sur- 
vive old ones. Thus, in the earthquake at Calabria, a man and his wife, with 
their child, were entombed by a falling house. On being dug out, the parents 
were found dead, and the girl alive. The nearer the individual is to the age of 
childhood, the less is the necessity for respiration; and hence, persons of manly 
age, and if not asthmatic, but of sound lungs, survive the aged, 
''in reference to the condition of the body, the most important point is the state 
of the lungs. A person with sound lungs will easily outlive another, whose lungs 
are indurated or suppurating, since an unfrequent, but perfect inspiration sufl!ices 
to preserve for a time, the functions of the lungs, while a short and confined one 
does not convey sufficient air to them. In reference to the situation, we assume, 
that those have died last, to whose lungs the access of air was in some degree pos- 

1843.] Medical Jurisprudence and Toxicology. 239 

But the possibility of obtaining respirable air, depends often on very different 
and apparently opposite circumstances. In a conflagration which broke out in 

this city ( ) in 1808, two persons by the ruins falling down before 

the door of the cellar, were inclosed therein. One was an old man of seventy, 
and asthmatic, the other a very healthy person, aged about forty. The latter 
stood upright, and was near suffocating, in consequence of a fine smoke, which 
penetrated into the cellar and filled the upper half thereof; the old man, on the 
contrary, who had sat down on the floor, experienced nothing of this inconveni- 
ence. A man, who with his daughters and his mother aged seventy, retired into 
a cellar, on account of a fire, was suffocated with his children; while his aged 
mother was taken out the next day, half dead, gasping for air, but recovered and 
lived some years thereafter. 

The nature of the masses which cause the entombment produce various effects, 
while the wounds depend on the masses causing them, the height from which 
they fall, and also the position in which the injured parts are. If large and heavy 
masses, ruins of walls, rocks, beams, stones, &c., fall upon the body, although 
the external wound may not appear severe, yet on dissection, we shall find the large 
blood-vessels, and the heart itself lacerated, and as the extravasated blood stains 
the parts, it is very difficult to decide whether the living man or his recent 
corpse was injured. Yet in the last case, the countenance is composed, or cer- 
tainly not so distorted, as when a man has died in great terror and pain, and re- 
ceiving very severe wounds. 

Masses which do not cohere together, as earth, sand, rubbish, &c., press 
together the injured parts heavily, without generally breaking them. They 
also separate the extremities from the trunk, while they press on the space be- 
tween, as, for example, between the arms and body. In the case of a female over- 
whelmed in a sand-pit, I found the body so much compressed, that it had scarce- 
ly half its natural thickness; besides this, however, there was no external injury 
observable. Occasionally portions of the falling masses press upon the open- 
ings of the softer parts, as in the eyelids, mouth, &c. The abdomen will be 
pressed together, and the contents of the imestines and bladder forced out, and 
sometimes even the contents of the stomach will be driven out through the 
mouth and nose. 

Should we find such persons in various situations and positions, and in which 
it is evident that the deceased could not have been placed after death, as with 
the extremities drawn from the body, the arms upraised, or resting like the feet on 
the ground, or if we find under the finger nails, sand, &c., as if the sufferer had 
endeavoured to extricate himself, or if some of these foreign substances are seen 
in the mouth and windpipe, it is beyond a question that such an one must have 
survived another, on whom these marks are not found. 

It was remarked of those who were entombed by the earthquake in Calabria, 
that the last position at the moment of death, of males, was an exertion of all 
muscles, in apparent struggling; while that of the female sex exhibited marks of 
the wildest despair. The latter, particularly, had their hands clasped above 
their heads. But when there were any children with the mother, she evidently 
thought only of protecting them, and with her own body endeavoured to ward 
off the danger. The father, on the contrary, seized his child and then opposed 
himself to it. Thus at Polestina, a mother with her two children, one a boy of 
three years old and the other an infant of seven months, was found. The infant 
was pressed to her breast, while her body was bent over the other, so as to op- 
pose her back to the falling ruins. !She held both children firmly inclosed within 
her arms, and in this position was found under the ruins. 

The following case was submitted for the opinion of Pyl. Two married per- 
sons had gone to bed in good health. The woman had, however, been for some 
months feeble, and suffered frequently from faintess and headache. In the stove 
was found some charred oak wood, there was also an extinguished lamp in the 
room, but no smoke or vapour could be discovered, although the ventilator was 

Both were found dead, and as was supposed, from the fumes of charcoal. The 

240 Progress of the Medical Sciences, [Jan. 

relatives raised a suit about the estate. Those of the husband contended that he 
must have survived, as he was of a robust constitution, and thus resisted the 
deleterious effects of the charcoal fumes longer than his feeble wife. Besides, 
his body was found warm in bed, while hers was cold. On the other hand, the 
friends of the wife objected, that it was not by any means certain that in all cases 
the weaker would yield sooner than the stronger. The body of the husband 
■was probably covered with the bed-clothes, and thus preserved its heat, whilst 
it was ascertained that that of the female was naked. They relied, however, 
principally on the fact that the wife was only 20 years old and the husband 21, 
and hence she, as the younger, must have survived. 

The following were the appearances externally and on dissection. Both 
were found in bed, the woman with folded hands, and body stretched out upon 
her back, while from the mouth issued a very fetid and rather bloody froth; and 
from the parts of generation light red blood, which also stained the bed-clothes. 
The husband lay near her also stretched out, but the upper extremities were stiffer, 
and his fingers drawn together convulsively. A blackish froth issued from 
his mouth. All the depending parts of the body in each was of a black and 
blue colour, but in neither could any mark of wound or injury be discovered. 
The odour of putrefaction was present, but the outer skin was firm. 

On the dissection of the female, the abdomen was found greatly distended; 
the intestines exhibited some livid spots; the stomach was much enlarged, its 
upper part inflamed and the blood-vessels swollen, while the inner surface con- 
tained large black spots of the size of a dollar, on which the villous coat was 
abraded. The impregnated uterus was inflamed on its surface. The lungs were 
pale and collapsed, and in them and in the heart the blood was small in quantity, 
but frothy, black, and fluid. The blood-vessels of the brain were greatly dis- 
tended with black, thin blood. 

In the husband the appearances were similar, but more marked. There was 
more serum in the abdomen, and the stomach was more inflamed. The liver 
dark coloured, contained much fluid, frothy blood. The lungs were more swollen 
here and there discoloured, and the vessels full of blood. The heart contained 
more blood than in the female, but the condition of the brain was very similar. 

The opinion of Pyl is to the following effect: While all cases of this descrip- 
tion are extremely perplexing, and it is indeed impossible to arrive at a conclu- 
sion with absolute certainty, the difficulty is here increased by the fact that the 
period of death in these persons is uncertain, and that both, when found, were 
already stiff and cold. Their appearance was that of ordinary sleep, neither 
their countenance nor their limbs were distorted, and it is hence highly probable 
that both were deprived of life at the same instant. They were apparently suf- 
focated during sleep, or otherwise we should have noticed some indication of 
an attempt to restore themselves. A few minutes at the most could have inter- 
vened between their deaths, and from the examination, it would appear that the 
effects on the husband were the most rapid and decisive, as shown by the state 
of the heart and lungs. Still, as the woman was the weakest, and was subject 
to faintings, she may have died first. In fine, it is impossible to answer the 
question in a positive manner. 

Our author objects to this indecision, and remarks that Pyl should have made 
a distinction between the various effects of the fumes of charcoal, as they either 
first attack the brain and cause faintness and apoplexy, or else suffocation 
(choking rheum). Now, on the body of the wife, no marks of the latter were 
discovered, whilst they were on that of the husband, and the probability there- 
fore is that the wife died first. 

Metzger has also noticed this case, and declares that he would have decided 
for the earlier death of the wife. 

(To be continued.) 

72. Detection of Lead in the Muscles paralysed hy it. — The following curious 
statement is taken from a paper in the Medico-Chirurgical Transactions^ vol. xxv, 
by Dr. William Budd, on the Symmetry of Disease. 

1843.] Medical Jurisprudence and Toxicology. 241 

Paralysis of the hands in house painters and white lead manufacturers, does 
not depend on affection of the nervous centres, but is a purely local effect of the 
poison. This is evident from the limitation of the paralysis. 

Lead has been detected in the palsied parts by direct experiment. This fact 
has been repeatedly ascertained by M. Tanquerel, and by MM. Devergie and 
Guibourt, and quite recently at Kiug-'s College Hospital. 

In a man who died there, under the care of Dr. G. Budd, of epilepsy from 
lead poisoning, and who also had wrist-drop, Mr. Miller detected lead in 
abundance in the paralysed extensors of the hand. T. R. B. 

73. Hydrated Proto-sulphuret of Iron, an Antidote to Corrosive Sublimate, — 
M. MiALTHE laid on the table of the French Academy of Medicine the following 
note : 

"It results from my experiments that the hydrated proto-sulphuret of iron, 
(an inert substance,) possesses the property of instantaneously decomposing 
corrosive sublimate, producing proto-chloruret of iron, and bisulphuret of mer- 
cury, both of which are quite innocuous. This precious property possessed by 
the hydrated proto-sulphuret of iron, causes me to proclaim it as an antidote to a 
terrible poison. I will in due time communicate my experiments to the Acade- 
my; but, in the mean time, content myself with stating a simple experiment by 
which its virtues can be easily tested. When a few centigrames of corrosive 
sublimate are introduced into the mouth, a disagreeable and well characterized 
metallic taste is spedily experienced: if a gargle of the proto-sulphuret of iron 
be used for a few seconds, it causes it to disappear as if by magic." — Land. ^ 
Ed. Month. Journ. Med. Sci. Sept. 1842. 

(We noticed this antidote in our preceding number, p. 496; but the journal 
from which we derived the information, erroneously gave the hydrated proto- 
sulphaie of iron instead of the sulphuret.) 

74. Cases of Asphyxia produced by the common Light Gas of Strasbourg. By Pro- 
fessor TouRDES. — A family, consisting of six persons, retired to their home on the 
evening of the 31st December 1840, and not making their appearance either the 
next day, or the second day thereafter, the neighbours broke open their doors at 
half-past ten of the 2d of .January. Five of the family were found stretched 
apparently lifeless on the floor, and the sixth on the bed. The father, forty-six 
years of age, gave some signs of life; the mother, forty-four years of age, uttered 
a few groans; the servant, eighteen years of age, was dead, cold, and stiff; two 
boys of fourteen and fifteen, were also cold and dead; the daughter, five years 
of age, was still warm. All means were used for their resuscitation, but the 
father died next day, and the mother alone recovered. 

A strong smell of gas was felt when the doors were first opened, and there 
was no other apparent cause for the fatal asphyxia of the family. 

The bodies were opened, and presented a marked similarity in the morbid 
appearances. In all, rose-coloured patches were noticed on the anterior and in- 
ternal part of the thighs, and the dermoid and subcellular structures below these 
spots were found highly injected with blood. The membranes of the brain were 
injected with blood in all, as was also the substance of the brain itself, and espe- 
cially its outer surface, which had a deep red tinge in consequence. In the 
father this was less remarked, as he had been freely bled several times. Clotted 
blood was found effused into the spinal canal between the membrane and bone. 

In those who had fallen victims to the deleterious gas before being seen, a 
viscid whitish foam with bloody streaks through it filled the mouth, larynx, and 
bronchii, and adhered to the membrane. The pulmonary tissue was throughout 
of a bright red-colour. The blood was of a black colour, coagulated, and accu- 
mulated not only in the heart, but also in the aorta and chief veins. The liver 
was of a decided red hue, from its whole structure being gorged with blood in 
four of them, but it was pale and of a yellowish gray in the°fifth. In four of 
them the bladder was distended with an enormous quantity of limpid urine. 
The cadaveric rigidity was well marked in all. 

242 Progress of the Medical Sciences, [[Jan. 

These morbid appearances present not the slightest similarity to those ob- 
served in two cases of asphyxia from the same cause, by Mr. Teale, and pub- 
lished in the eighth number of Guy's Hospital Reports, and in the 14Ist number 
of this Journal, p. 576. They resemble much more the cases of asphyxia result- 
ing from the breathing of carbonic acid vapours, or the vapours arising from 
burning charcoal or coal; indeed, the appearances correspond very closely with 
those detailed by Dr. Golding Bird, in a paper on "• Poisoning by the Vapours 
of Burning Charcoal and Coals," published by him in the same number of Guy's 
Hospital Reports, an extract of which is also given in the 141st number of this 
Journal. — Ed. Med. ^ Surg. Journ., Jan. 1842, from Gaz. Med. de Strasbourg, 
Aug. 1841. T. R. B. 

75. Researches on the specific Odour of the Blood. By Dr. C. Taddei de Gra- 
viNA. — The object of the experiments whose results are given in this paper, was 
to test the truth of the well-known principle laid down by Barruel, and more or 
less acknowledged by other chemists, that the blood of each individual exhales 
an odour closely resembling that of the cutaneous perspiration, and so peculiar 
that the species, and even the sex of any animal from whom a given quantity of 
blood has been drawn, may be determined by it. 

The details of the previous investigations may be found in any extended work 
on medical jurisprudence; those of the present included examinations of the 
blood of the ox, cow, and very young calf, an old and a very young hare, the 
goat, sheep, hog, horse and mare, dog, man and woman, and numerous species 
of birds. The blood of each was subjected to the action of pure sulphuric acid, 
and, in the exhalations that were then given off, the peculiar odour was in every 
case perceived. The only case in which the odour of one kind of blood could 
be confounded with that of another were those of the ox, cow, and sucking calf, 
and those of the hare and leveret; but in each of these cases the aromatic prin- 
ciple of the blood of the adult animal, though similar to, appeared stronger and 
more fragrant than that of the young, although the respective quantities of each, 
and of the sulphuric acid with which they were treated, were the same. Nor 
were the odours of the blood of a man and of a woman unlike each other, nor 
those of the horse's and mare's blood. The odour of the blood in each case 
was not different from that of the cutaneous exhalation of the several animals; 
and, in like manner, the blood of several cocks and hens, and of not a few 
pigeons subjected to the action of sulphuric acid, or left to putrefy, always ex- 
haled a peculiar odour; in the former case reminding one of that perceived on 
entering a poultry-house, and in the latter of that of a dove-cote; odours which 
are also exhaled from the skin of the chest and under the wings of those birds. 
An odour, analogous to that of these parts of the skin, was given out under 
similar circumstances from the blood of thrushes, sparrows, linnets, goldfinches, 
woodcocks, and turkeys; and none of these had in its odour anything in com- 
mon with that of the above-mentioned mammalia or of man, or of any of the 
species of birds. It follows, therefore, 1st. That it is true that the blood of 
every vertebrate animal has in it an odoriferous principle, identical in all the 
individuals of the same species, and similar to the odour of the cutaneous tran- 
spirations, or, more properly speaking, of that part of it which gives to each ani- 
mal its characteristic smell. 2d. That the notion of those who pretend to recog- 
nise to which, among a number of individuals of the same -species, a given 
portion of blood belongs, is false. 

After obtaining these results, the author proceeded to the similar investigation 
of the blood of persons labouring under different diseases and under various 
other peculiar circumstances; but in none of these cases could he detect any cor- 
responding differences in its odorous exhalation. From all these, therefore, his 
conclusion is, that neither the differences of age, of constitution, of temperament, 
of sex, of habit and customs, or of modes of living, nor diseases, medicines, or 
pregnancy, induce any change in the specific aroma of the human blood, but that 
it always preserves the same general odour; being only sometimes more fra- 
grant and acid, or more garlicky and nauseous in some than in other persons. — 
B. ^ F. Med. Rev,, Jan. 1841, from Jinn. Univ. di Med. Feb. 1840. 

X843.] 243 


Case of Salaam, Convulsion. By S. A. Barton, M.D., of Village 
Green, Pennsylvania. — A case of the above rare disease, only seven cases 
of which have been recorded in Europe, and, so far as I am informed, 
not any in the United States, recently came under my observation. Satis- 
fied, from the peculiarity of the symptoms, that it is the identical disease 
described by Mr. West, (See this Journal for July, 1841, p. 187,) and one 
or two other eminent physicians in London, I am induced to write out a 
history of the case, and send it for publication in your Journal. 

Mary E., daughter of T. E,, of Delaware county, Penn., a robust, 
healthy, and intelligent little girl, seven years of age, was taken about 
midnight of the 26th of last November with fever, accompanied with pain 
in the head, and slight pain in the right side of the chest, and a short time 
after with convulsive jerkings of the extremities and head, so much so 
that her father, who represented the case to me, had some difficulty to hold 
her in bed. After the spasmodic tvvitchings had somewhat subsided, which 
occurred in a few moments, her feet were placed in warm water, and a 
small dose of ol. ricini administered; the spasms having entirely subsided, 
she was again placed in bed, broke out in a gentle perspiration, and slept 
comfortably until morning. She arose in the morning apparently as well 
as usual, and continued so until noon^ when she was taken similarly as in 
the night, and I was summoned to visit her; when I arrived I found her 
but little amiss, playing with some pieces of money, the spasms having 
passed away for the time being. 

Having had the case represented to me as above, her father at the 
same time expressing a wish that 1 might see her in one of her "spells," 
I remained near an hour without prescribing, as she appeared to be en- 
tirely free from disease, when she was taken with a slight spasm or con- 
vulsive jerk of her extremities forward, and a boiving of the head, with 
instantaneous relaxation, which were repeated at intervals of a few 
seconds, accompanied with a quick expiration and noise, such as would 
be produced by a sharp blow upon the epigastrium. The spasms in- 
creased in intensity for perhaps ten minutes, at intervals of from ten to 
twenty seconds, instantaneously relaxing in every instance. The pecu- 
liar nodding or bowing motion of the head was striking, inducing Mr. 
West to give it the name of "Salaam convulsion." 

In the case of Mr. West's son, there was entire consciousness through- 
out the disease; in the above case, also, the mind was not in the slightest 
degree affected; immediately after relaxation of spasm, the child would talk, 
laugh, and attend to some play-things she held in her hands, as though 
nothing was the matter. The motions of the head and extremities were 
constantly forward and approaching each other. 

The case presented an aspect so novel to me, having never noticed a dis- 

244 American Intelligence. [Jan. 

ease similar before, that I was at a loss to decide upon the plan of treatment. 
Supposing, however, it might depend upon acrid ingesta, or perhaps worms, 
I prescribed a brisk cathartic, and ordered the child's feet to be placed in 
the warm bath. In about twenty minutes the convulsive jerkings had en- 
tirely subsided; she left the nurse's lap, ran about the room, playful and 
cheerful, demanded some food, which was given her, and of which she ate 
with good appetite. 

The following morning I again called to see her; the purgative had 
operated freely; had had no return of spasms; apparently as well as usual, 
and has continued well up to the present period. 

About one year since she had a similar attack, as I learned, and was 
visited by my friend Dr. T. Young, upon which occasion the spasms gave 
way upon the exhibition of a cathartic, but was followed by fever of seve- 
ral days continuance. Remarks upon its pathology must of course be spe- 

Notice of a Malignant Epidemic zvhich prevailed in the Lying-in 
Department of the Philadelphia Hospital (Blockley) in March and April, 
1842. By M. W. Wilson, M.D., Resident Physican. (Communicated 
by R. M. Huston, M. D., one of the attending Physicians.) 

During the months of March and April of 1842, a malignant epidemic 
prevailed in the Lying-in Department of the Philadelphia Hospital, which 
proved fatal to several patients, and was not arrested until the patients were 
removed to another part of the building. 

For some time previous to the commencement of this epidemic, all dis- 
eases met with in the hospital had assumed an adynamic character. Typhus 
fever was of frequent occurrence and in many cases it proved fatal, more 
particularly when the patients were far advanced in life. Erysipelas had 
also been epidemic, and several cases had occurred in the patients in the 
lying-in department. When the epidemic of puerperal fever commenced, 
that of erysipelas was on the decline, it however still existed. 

The epidemic which prevailed among the parturient women, com- 
menced about the middle of March, and continued until the latter part of 
April, when the wards were abandoned, and nearly all the patients left the 
house. During the time above specified, thirteen women were brought to 
child-bed in the white lying-in wards, nine of whom had an attack of the 
fever, and to six it proved fatal. In the black lying-in wards there were 
six births, and but one woman had an attack of the fever, and she died. 
This case presented some anomalies and will be referred to hereafter. Two 
other women had more abdominal tenderness than usual, and some fever, 
but these symptoms disappeared after the removal of the patients to sepa- 
rate wards. 

Of the thirteen children that were born in the white lying-in wards, one 
was still-born, and five died about a week after birth with peritonitis. The 
mothers of five of these children, including the still-born child, had an 
attack of puerperal fever, three of whom died, while the mother of the 
sixth escaped the disease entirely. The seven remaining children lived. 

The disease usually commenced from two to four days after labour, and 
was ushered in by a severe rigor. In one case the rigor commenced im- 
mediately after the termination of labour. As soon as the patient reacted 
from the chill, the characteristic symptoms were observed. The counte- 
nance became very anxious, and expressive of pain; there was much abdo- 

1843.] American Intelligence, 245 

minal pain and tenderness, tympanitis, and an entire suppression of the 
lochia. The tongue became red and dry at the tip and edges, and covered 
in the centre with a yellowish coat. The pnlse immediately rose to 90, 
and from that to 120 per minute. In two cases where it did not exceed 
90, it was full and hard, bnt in the others, when it exceeded 110 per 
minute, it was small and slightly corded, but readily yielded to pressure 
under the fingers. The pulse increased in frequency as the disease pro- 
gressed. The pain of the abdomen during the earlier stages, came on in 
paroxysms, leaving the patient quite free from it in the interval. But as 
the disease advanced, the paroxysms became much more frequent, and in 
the latter stages the pain was constant. The tenderness of the abdomen 
was so great in some cases, that the patient would scream in agony from 
the gentlest touch of the hand, while others, particularly in the early stage, 
were mucli relieved by equitable but firm pressure over the abdomen. The 
abdomen became enormously distended in the latter stages; in some cases 
it became as large or larger than it was before confinement. The milk di- 
minished in quantity from the commencement, and entirely ceased on the 
second day. 

; In a few cases cephalalgia was present from the onset, and became very 
violent before the disease terminated. The bowels were disturbed but in 
a single case, and that was the black woman, and she had complained of 
a great frequency of stools for a day previous to labour. 

The skin, which at first was hot and dry, became moist and clammy in 
the latter stages of the disease. 

In those patients who recovered, the commencement of convalescence 
was marked by the absence of pain, and the diminution of tenderness of 
the abdomen. The lochia appeared, and the tongue assumed a moist and 
creamy appearance, and the pulse approached the natural standard. 

In those cases where the disease approached a fatal termination, all the 
symptoms mentioned above increased in severity. The countenance be- 
came fallen and haggard, the tongue and mouth dry and parched; sordes 
collected on the teeth; the extremities became cold; low muttering deli- 
rium, and death followed, generally about the fourth or fifth, and in one 
case on the second day from the attack. 

An examination of the body after death exhibited a dark-red injection of the 
peritoneum throughout its whole extent. The cavity of the peritoneum contained 
some reddish serum, mixed with flakes of lymph. The parietes of the uterus in 
some cases appeared softened. On cutting the uterus open, the internal surface 
was found lined with a dark-red, tenacious mass, which was more firm, but in 
other respects appeared like clotted blood. In some places this substance ap- 
peared to penetrate the substance of the uterus. The veins of the uterus were 
not examined in every case, but in those in which they were examined, that con- 
dition described by Dr. Robert Lee, in the Cyclopedia of Practical Medicine, 
was not ol^served. The other organs were healthy, except in the case of the 
black woman, of whom mention was made above. In this case the mucous coat 
of the intestines was injected more than usual, particularly at the ccecal extre- 
mity of the ileum. The glands of Peyer were ulcerated, and presented an ap- 
pearance very similar to what we meet with in typhoid fever. The large 
intestine, on its internal surface, was covered with a deposit of coagulated lymph, 
and resembled the skin covered with warts. In this case the inflammation of 
the peritoneum was not so well marked. The condition of the uterus was the 
same as in the other cases. 

The treatment made use of consisted of a constant application of a 

246 American Intelligence. [Jan. 

warm flaxseed cataplasm, large enough to cover the whole abdomen. This 
was applied during the chill, and continued throughout the course of the 
disease in every case. In a few cases leeches were applied to the abdo- 
men, and in one case to the neck of the uterus. Blood-letting from the 
arm was practised in two cases, soon after reaction from the rigor, when 
the pulse was full and hard, and did not exceed ninety in frequency. 
Both of these cases terminated fatally, and the duration of the disease was 
shorter than usual. In the first case, small doses of blue pill were admin- 
istered at intervals, with the view to its constitutional effect; but it neither 
affected the gums nor arrested the disease. Anodynes were prescribed to 
allay the pain, and with temporary benefit. The remedies that seem.ed to - 
have the most happy effect, were calomel combined with ipecac and 
opium powder, given in large doses. From eight to ten grains of the 
former with fifteen of the latter, were given every four hours, until the 
pain ceased or was much mitigated. When given in this way, the calomel 
neither disturbed the bowels nor affected the gums. One patient recovered 
under this treatment who had presented symptoms as violent as any other 
that occurred during the time the epidemic prevailed in the same stage of 
the disease. This patient took thirty-two grains of calomel, and a drachm 
of ipecac and opium powder, in sixteen hours, at which time the pain 
entirely left her, and she convalesced rapidly afterwards. 

In the latter stages of the disease, a variety of remedies were resorted to 
without any apparent benefit, such as raising the epidermis over the abdo- 
men, and covering the surface with camphorated mercurial ointment. 
Sinapisms were applied to the extremities, and ammonia, and brandy, and 
egg^ with other stimulants given internally. 

When the abdomen became so enormously distended as to interfere 
with respiration, producing alarming dyspnoea, as it did in some cases, 
the rectum tube was used, and injections of turpentine, assafoetida, &c., was 
resorted to. 

Cases of Closure of the Vagina in Infants after birth. By J. C. 
NoTT, M. D. 

Case I. — In the early part of 1837, I was requested to see the infant 
daughter of Mrs. P., of Mobile, aged 12 months. The mother and nurse 
both affirmed that the child was healthy and free from any deformity at 
birth, and for at least three or four months afterwards. They further 
stated that they had accidentally discovered, a few days before consulting 
me, that the vagina was closed, but were unable to say at what time this 
had taken place, as there had never been any inflammation, discharge from 
the parts, or any circumstance to attract particular attention. 

On examination, I found a perfect adhesion of the labia, and closure of 
the vagina — the orifice of the urethra alone remaining open. The ap- 
pearances were those of a congenital deformity, the parts being healthy, 
and the position of the os externum being marked by a superficial sulcus. 

The child was teething, and as I saw no good reason for immediate in- 
terference, I advised that nothing should be done until this period was gone 
through. The parents, with the child, went to Scotland to spend the 
summer, and when they returned in the winter, I found, on examination, 
that the vagina had opened spontaneously — the parts were perfectly 
natural, and have remained so ever since. 

Case II. — In July last, Dr. McNally called on me, and asked me to see 

1843.] American Intelligence, ' 247 

with him a child, about the same age, and under circumstances so similar 
in every respect, that I deem any details unimportant. I related the above 
facts to him, and we agreed to leave the case to nature for a few months. 

We have recently examined this patient again, and find that a sponta- 
neous opening has taken place as in the other case. 

Remarks. These cases are not of frequent occurrence, are not to be 
found in our common works on surgery and diseases of children, and may 
embarrass the inexperienced practitioner. There can be no objection to 
the delay of an operation, and it is always prudent to avoid cutting if 

Mobile, 6th Dec. 1842. 

Cimicifuga and Iodine in Incipient Phthisis. — Dr. Chs. C. Hildreth,* 
in an interesting paper on this subject in our last No. (p. 281 et seq.) states 
that " to whom we are indebted for the original introduction to the notice 
of the profession of the Black Snakeroot in Phthisis, I am not able to dis- 

This observation has attracted tlie attention of Dr. F. J. Garden of 
Wylliesburg, Charlotte, Va., who writes to us, to assert his claim to that 
merit, and refers in support of it to his paper "on the use of the Actaea 
Racemosa in Phthisis Pulmonalis," published in the American Medical 
Recorder for October 1823, which, he says, is the only essay up to that 
time in print on the subject. 

*' I have been an attentive reader," Dr. Garden writes, " of the Medical Re- 
corder and Journal, for twenty one years past, and since my first publication, have 
watched with intense anxiety the progressively increasing claims of this remedy 
to merit, lest, as then stated, "I should be thought the boasted discoverer of a 
remedy, which had no claims to merit, except in the imagination of its inventor." 
The pages of the Journal bear testimony to the fact, that it has since been used 
in various forms of cough, in the Northern States, and that whenever it has 
been wielded, by a skilful hand, one who knew when and how to control and 
modify its action, by combination or other circumstances, 1 find it has always 
been used with g^ood effects. Like all other remedies, this may be the proper 
one, yet it may fail for the want of tact in its administration. By tact I do not 
mean skill; one man may succeed with a certain remedy in producing effects, 
which no other can; not because he is a man of superior skill, but because he has 
noticed and watched its effects more closely. I must not be understood as in- 
sinuating tliat I am at all in advance of others upon this point. 

"The Cimicifuga, is no less successful in chorea, than in various forms of 
pulmonary disease. 1 once treated a case of chorea successfully, by means of 
this remedy alone, in a little boy, after the usual and most approved remedies 
had been previously, perseveringly, and diligently used, for some time without 
effect. It was given in form of powder in tea-spoonful doses twice a day, in 
a little molasses. Its effects were prompt and decisive: I confess however its 
administration in this form of disease, had not been thought of by me, until my 
attention had been awakened by a publication in the Medical Journal six or 
eight years ago, in which the writer detailed several cases successfully treated 
by him. I am not at present able to lay my hands upon the- paper, after a 
careful and diligent search; I must, however, acknowledge my obligations to the 
author; he, like myself, was induced to use it upon vulgar report: some old 
woman put him in possession of the remedy. 

"In my own person were united all the prominent symptoms of phthisis, as 
quick breathing, frequent pulse, diarrhoea, night sweats, hectic action, irregular 

* Our correspondent doubtless refers to the paper of Dr. Young; see this Journal for 
Feb. 183-2, p. 310, vol. ix. 

248 Jlmerican Intelligence, [Jan. 

paroxysms, cough, purulent expectoration, &e. &c. Efficient doses of the Cinni- 
cifnga in Tincture, say from one, to one and a half ounces, undiluted, prepared 
of good old rye whiskey, taken twice a day before meals, arrested in a very few- 
days the entire catenation of symptoms, except the cough, and expectoration, and 
these not half so distressing. 

" I saw and conversed with a number of distinguished physicians, and sought 
their advice and undisguised opinions, all of whom, with a single exception, 
pronounced my case a forlorn one. In a letter addressed to me by Professor 
Dudley of Lexington, in reply to one which informed him of my recovery, he 
uses the following emphatic language: * Your recovery is a signal triumph over 

*' The Cimicifuga also combines in its qualities decidedly alterative powers, 
and hence perhaps results its tonic action; for without puking, sweating, or 
purging, or any other obviously operative effect, besides those detailed in a 
former publication, the appetite and strength improves rapidly. My remarks of 
course must be construed as applying, to those pathological states of the sys- 
tem, alone, to which its use is applicable. To administer a remedy in states of 
the system in which it is not indicated, is sufficient of itself to insure its own 

" Whenever the hepatic secretions are deranged, its action is greatly assisted 
by preparing the patient with a dose or two of calomel, whether the tincture or 
infusion, either hot or cold, is the form of administration preferred, for it yields 
its powers freely to all of these menstrua. A light diet too is a matter of pri- 
mary importance. In one case in which its powers were displayed as happily 
as in any other, the patientconfined himself to a glass of buttermilk, and a little 
corn bread three times a day. This was not a case of phthisis, but derangement 
of the stomach and liver, in a lymphatic temperament, which had obstinately 
refused to yield to other treatment; for, as is usual in such constitutions, the mer- 
curial plan rather served to aggravate and irritate. Six weeks perseverance 
with this treatment, unaided by any other remedy, restored the patient to the 
most perfect, vigorous and robust health, which continued permanent." 

Medical Notes. By George Colmer. — Paralysis in Teething Chil- 
dren. — Whilst on a visit to the parish of West Feliciana, La., in the fall 
of 1841, my attention was called to a child about a year old, then slowly 
recovering from an attack of hemiplegia. The parents, (who were people 
of intelligence and unquestionable veracity,) told me that eight or ten 
other cases of either hemiplegia or parapligia, had occurred during the 
preceding three or four months within a few miles of their residence, all 
of which had either completely recovered, or were decidedly improving. 
The little sufferers were invariably under two years of age, and the cause 
seemed to be the same in all — namely, teething. 

Intense Smarting of the Skin caused hy the endermic use of Iodine. — 
In a case of enlarged spleen, I lately made use of the ungtientum iodini 
with my own hand, on a male adult, but hardly had I commenced inunc- 
tion before the patient complained loudly of an agonizing smarting and 
burning of the skin, and in a few minutes more, became so boisterous, that 
I was compelled to grant him an anodyne to relieve his suffering. A 
few days afterwards, I repeated the process, and the same result following, 
I was obliged to abandon its further use. 

Case of Neuralgia. — During the night of the 15th October, 1841, 
Thomas Burnett, a white lad of seven years of age, of previously robust 
health, was attacked with neuralgic pains on the inner side of the right foot 
and calf of the leg; the next night, at the same hour, the pains returned, 
snd reached to the inside of the thigh; the third night, they arrived at the 

1843.] American Intelligence, 249 

lumbar spine; and the fourth and subsequent nights, they not only ex- 
tended to the other leg and thigh, but also to the upper portion of the spine, 
to both the upper extremities, and occasionally to the face and scalp. The 
pains were intermittent and lancinating, and so severe as to make the little 
sufferer writhe and scream with agony every five or ten minutes. The par- 
oxysm generally lasted from six to eight hours. The pulse was accelerated, 
but only at times; and during the transitory intervals of ease, a copious 
perspiration would sometimes suddenly break out, but almost as rapidly 

Taking into consideration the perfect regularity in the return of the at- 
tacks, I resolved on employing as an anti-periodic, the sulphate of quinine, 
which I did in five-grain doses, during the intervals of the paroxysms, to 
the extent of from 30 to 40 grains daily, combined with one-fourth the 
quantity of camphor. The bowels were kept in a soluble state with cas- 
tor oil. During the paroxysm, I gave in divided doses, about half a grain 
of the sulphate of morphia, with half an ounce of the sweet spirits of nitre. 
Under this course, I had the satisfaction to see the disease yield gradually 
but completely, in less than a fortnight; and up to the present time (Nov. 
1842,) it has not returned. 

Child horn with Small-pox eruption, the mother not having had the disease. — The 
followin<T very curious case has been communicated to us by our correspondent, 
Dr. B. F. JosLiN, of New York. It has already been published in a New York 

"On the 27th of April, 1842, the wife of .fohn M , residing in Fourth 

street, gave birth to a male child, after a natural labour, about eiofht or nine days 
before the expiration of the ninth month, according to her reckoning. It was 
apparently lifeless; but on means being used for restoring animation, it breathed 
faintly a few times, but in a quarter of an hour expired. I found on its body, 
about 170 regularly formed small-pox pustules, of the usual size, and filled with 
yellowish purulent matter. They were generally of a regularly circular form, 
except on some parts of the hands and feet, where their close proximity had pro- 
duced confluence. Next to the hands and feet, the parts most affected were the 
legs, arms, hips, and posterior part of the pelvis. Most of the pustules were 
about one-fifth of an inch in diameter, some of them quite prominent, but most 
of them rather flat and fiaccid, and the matter rather thin. The process of scab- 
bing had not commenced, the pustules being apparently at the stage at which 
they would be found in ordinary cases about eight or ten days after the incursion 
of the disease. 

" The circumstances were such as to fix with some precision the lime when the 
infection had been received by the mother, which must have been just thirty 
days previous to the birth of the child. That was the only time of her exposure, 
which was to a single case at the very commencement of the eruption, and for a 
single day. I was at that time sent for to pronounce on the nature of the inci- 
pient eruption. This was not the stage of maximum activity of the effluvia; yet 
there was no other medium; no contact with the body or clothing of the patient. 
The infection must have been received by inhalation. 

" About thirty years previous to this time, the mother of the child had, in early 
childhood, received vaccination, and effectually, as was subsequently proved. 
For not only was she vaccinated by me on the day of this exposure without 
effect, but the infection which communicated genuine and fatal variola to the 
foetus in utero, must have been transmitted through the blood of the parturient 
female, without producing at any time in herself the slightest varioloid symp- 

" Though cases like the above are rare, several have been recorded, and one 
occurred to Jenner hiinself. In the mode of transmission there is still some 

250 American Jntelllgence. [Jan. 

mystery, the solution of which might throw light on some other curious points 
in physiology and pathology. Such cases show a sufficient connection between 
the maternal and foetal circulation to allow through its medium the transmission 
of a portion of the inconceivably dilute virus, in sufficient quantity to infect 
the foetus. I say inconceivably dilute, for in cases like the above, where the 
mother is not disordered, there appears to be no multiplication of the particles of 
virus by any leavening process. Yet on the other hand, where the mother is 
affigcted, the foetus in some cases is not. 

*'The fact that the pustules of small-pox patients are found on the skin but 
never on the viscera, has been attributed to the influence of air; but their exist- 
ence on the skin of the foetus, and in some instances in such numbers as to 
cover it, is incompatible with this hypothesis. I believe it has not been shown 
that the liquor amnii possesses properties which might be supposed to enable it 
to perform this office vicariously. This determination to the surface seems 
rather to result from an inherent centrifugal tendency, a beneficent provision for 
the relative security of the vital organs." 

Weis^ht of New-born Children. — This subject has been but little attended to in 
this country, and every contribution to it is therefore valuable. Dr. Storer states, 
that he has found a great disinclination, and at times, a decided unwillingness 
on the part of friends, to have the infant weighed. Of thirty children, fourteen 
females weighed 112 pounds, or averaged 8 pounds each; and sixteen males 
weighed 145:1^ pounds, or averaged 9 pounds each. The males and females 
weighed together 257 pounds, or averaged 8| pounds each. The largest child 
seen by Dr. Storer, was a male and weighed 13 pounds; the next in weight 
was 13^ pounds. One weighed 11, one 10|, and two 10 pounds. The smallest 
infant was a female, it weighed 1 pound 14 ounces, and lived eighteen hours. — 
New England Quarterly Journal of Medicine ^ Surgery,, July 1842. 

Humerus fractured by a musket-ball — artificial joint — Dr. W. L. Sutton, of 
Georgetown, Ky., relates in the Western Journ. of Med. ^ Surg. (Oct. 1842,) 
the interesting case of a man, who was shot in the arm, the ball passing through 
the humerus, immediately above the condyles. It would appear that no very 
strict treatment was pursued. After some weeks, he regularly bent his arm 
every day. This arm got well with the elbow stiff, and an artificial joint at the 
place of fracture. "This artificial joint supplies the place both of the elbow- 
joint, and of the rotatory motion of the forearm, in a very perfect manner, and he 
is able to do a good day's work or any kind of labour." 

Malignant Diseases of the Uterus. — Dr. Bigelow reported to the Boston Society 
for Medical improvement, on the 9th of May last, the following interesting case 
of malignant disease of the uterus, which occurred in a lady, fifty-four years of 
age. Dr. B. saw her first a year ago last June. A year or more previous to 
this, she had discovered a tumour in her right hypogastrium, extending up, and 
at length occupying the whole lower part of the abdomen. As felt externally 
it appeared to be about five or six inches in diameter. It was attended by no 
pain, but at times by a slight tenderness on pressure. One of its most uncom- 
fortable symptoms was a very foetid discharge from the vagina. On examina- 
tion by the vagina, the os uteri was felt closed, hard and corrugated; the neck 
nearly obliterated. Through the rectum the same tumour was observed more 
distinctly, extending abruptly back, occupying the whole lower curvature of the 
spine. It went on increasing for some months, giving much discomfort from the 
discharge, and bearing-down pains which at times attended it. At one of his 
examinations. Dr. Bigelow found the os uteri open, and a soft insensible sub- 
stance protruding. Some portion of it he was able to get away, and found to 
consist of a cerebriform substance, with some coagulated blood. At subsequent 
examinations he found the os uteri more dilated, and was able to remove still 
more. The operation was accompanied by some hemorrhage, but no pain. It 
appearing to be not a tumour of the uterus, but something contained within it, he 

1843.] American Intelligence. 251 

determined to try the effect of erorot in expelling it. He accordingly prescribed 
15 grains every half hour. He had scarce reached home when he was called 
back, and on returning found the patient in extreme, unremitting bearing-down 
pains, like those which usually follow the exhibition of ergot. They were so 
intense that he was obliged to give laudanum freely to check them. Immedi- 
ately after, upon examination, he foimd and removed from the vagina a large 
mass of cerebriform substance amounting to between one and two pints. Con- 
siderable hemorrhage followed, but the patient was much relieved as to the size 
of the tumour and the other symptoms. Previously the tumour had been so 
large as to press upon the rectum, and obstruct the passage of its contents, so 
that even cathartics and enemata could with difficulty be made to operate. This 
mass was removed in April. She continued to be very much improved in 
health, though annoyed by the foetid discharge. In the latter part of August, a 
more satisfactory examination was made, and the tumour was found to be con- 
nected with the inside of the uterus by a large pedicle. Thinking it might now 
be removed by ligature. Dr. Bigelow carried to the house the apparatus for the 
purpose. But in pulling down the tumour, while endeavouring to apply the 
ligature, the whole broke off and left only a stem behind. The hemorrhage was 
considerable, but no greater than in some of the previous operations. The symp- 
toms almost immediately ceased. The discharge in a great measure ceased, 
and the tumour nearly disappeared. Her general health greatly improved. She con- 
tinued well through the early part of the winter, but towards the close the abdo- 
men began again to enlarge, and the discharge returned. The tumour gradually 
rose till it reached the umbilicus; sometimes quite tender, but never very pain- 
ful. From time to time portions were detached and removed. Her health con- 
tinued to decline. Anorexia, nausea and vomiting occurred, under which she 
sunk, became delirious, and died in 24 hours. At the autopsy the uterus was 
found much enlarged, being 7 inches in length, and 5 in width, and almost uni- 
versally adherent to the neighbouring parts, viz. the ccecum, small intestines, 
rectum and bladder. On cutting it open, the parietes were found from one and 
a half to two inches thick. The cavity was enlarged, somewhat ragged, dark 
coloured, and contained a black secretion of a fcetid and gangrenous odour. The 
cavity was continued into the right Fallopian tube, which was so dilated that it 
would admit the little finger. There was a perforation at the fundus of the ute- 
rus, which was only prevented from penetrating the peritoneal cavity by the 
adhesions of the intestines. The portion of the tumour which remained was 
composed of the same cerebriform substance which had been removed. — The 
New England Quarterly Journ, Med. Set., Oct. 1842. 

Fracture of the scaphoid cavity of the radius— fracture of the lower end of the ulna. 
— The two following cases of this accident are related by Dr. W. L. Sutton, of 
Georgetown, Ky., in the Western Journal of Medicine and Surgery^ Oct. 1842. 

Case I. — Mrs. P., Sept. 4th, 1838, was thrown from her carriage, and received 
her weight on the left hand and forearm, by which the scaphoid cavity of the 
radius was split, and the lower end of the ulna fractured just above the styloid 
process. I dressed the fracture in the usual way, and by attention, I had as 
much gratification as the most unqualified satisfaction expressed by the lady and 
her friends could give; yet I could see, that although there was no absolute de- 
formity, still there was a want of symmetry, which I was much mortified to see 
in a lady's arm, especially as it occurred under my own management. 

Case II.— Nov. 1839, A. G., a carpenter, middle aged, fell about eight feet 
upon his hands, splitting the glenoid cavity of the left radius, and of course 
having a dislocation of the wrist. Being much dissatisfied with the usual mode 
of dressing in such cases, and having seen a statement of Dr. J. R. Barton's 
mode of treating them, I determined to try it. Having the arm properly ex- 
tended, I appled a roller upon the hand and forearm, securing a compress some 
third of an inch thick, and two and a half square, on the carpus and back of the 
hand, and a similar one on the palmar side of the radius, just above its carpal 
extremity, in such a way that the superior extremity of one corresponded with 

252 American Intelligence. [Jan. 

the inferior edge of the other. Over these I applied two thin but firm wooden 
splints, long enough to extend from the elbow to the points of the fingers. After 
a week the dressings were removed and reapplied daily, pressing the fractured 
portion of the radius firmly so as to prevent displacement, whilst the fingers 
and wrist were fixed and straightened; and after ten or twelve days adding pro- 
nation and supination to these motions. At the end of treatment the wrist was 
found perfectly symmetrical. 1 hold myself under much obligation to Dr. Bar- 
ton for instruction on this point. 

Pereira's Materia Medica. — We have the pleasure to announce that this valu- 
able work is rapidly passing through the press, and will be soon ready for pub- 
lication. The additions by the American Editor, Dr. Carson, and there is no 
one more competent to the task, are numerous and important; and consist in the 
introduction of the preparations of the U. S. Pharmacopoeia, with their formulae, 
and of many articles belonging to our indigenous Materia Medica, with their 
history, uses, preparations, &c. Dr. Carson has also inserted the nomenclature 
of the U. S. Pharmacopoeia, and added various notes which embody much useful 

The Medical Student'' s Guide., being a compendious view of the Collegiate and 
Clinical Medical Schools y the courses of private lectures, the Hospitals and Jllrns- 
houses, and other Institutions which contribute directly or indirectly to the Great 
Medical School of Philadelphia, with the regulations of hours, fees, ^c. and other in- 
formation of importancce to Students. 1842-3. Dr. Heber Chase has published 
under this title a small volume of one hundred pages 12mo, which will be of 
the greatest use to students. The author very truly remarks that " many and 
perhaps most, of the collegiate pupils remain ignorant of the advantages which 
surround them, beyond the walls of the school of their selection, until the course 
of study is verging to a close, and these advantages are no longer available. 
Many have bitterly regretted this ignorance in after life, and not a few have 
incurred considerable expense and sacrifice of practice, by returning, after seve- 
ral years of experience in these deficiencies, to acquire that knovi/ledge of some- 
special subject, which, during their noviciate, they did not know to be obtain- 

Dr. Bolionh Treatise on Strabismus. — In the notice of this little volume in our 
last No., it is stated that " Not the slightest allusion is made to the fascia of the 
eye, described by Tenon, a knowledge of which is so important for the perform- 
ance of the operation for strabismus, and to which attention has lately been 
called by Lucas, Ferral, Bonnet, &c." On this point it seems that injustice has 
been done to the author. For though no mention is made of that structure in 
the preliminary section, devoted to the anatomical relations of the parts concerned 
in the operation, and where it would be naturally looked for, there is actually a 
cursory allusion to it in a note on p. 16, and again at pp. 21 and 25. 

We honestly strive to mete to all the full amount of credit to which they are 
entitled, and whenever we fail to do so in the slightest particular, we shall al- 
ways hasten to repair the injustice. 

Necrology. — It is with regret that we announce the death of our correspondent, 
Dr. M. Morrison, which took place at the city of Havana, Cuba, on the 14th 
of Sept. last. Dr. M. was a graduate of the University of Maryland, and for 
several years resided in Buenos Ayres, where his achievements in surgery were 
of a very brilliant character, and will perpetuate his name. An account of some 
of these operations were recorded in the No. of this Journal for Feb. 1837. 




No. X.— April, 1843. 17 


Elisha Bartlett, M. D. Professor of 
the Institutes and Practice of Medicine 
in Transylvania University. 

T. RoMEYN Beck, M. D. Professor of 
Materia Medica in the Albany Medi- 
cal College. 

John B. Beck, M.D., Prof of Mat. 
Med. in the Coll. of Phys. 4" Surg. 
JV. York. 

Jacob Bigelow, M. D. Professor of Ma- 
teria Medica in Harvard University, 

A. Brigham, M. D. Superintendent and 
Physician to the New York Insane 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 

B. H. CoATES, M. D. of Philadelphia. 
D.Francis Condie, M. D. of Philadel- 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of the State of 
South Carolina. 

Gouverneur Emerson, M. D. of Phi- 

Charles Evans, M. D. Attending Phy- 
sician to the Friends^ Asylum, Frank- 

Paul F. Eve, M. D. Professor of Sur- 
gery in the Medical College of Geor- 

John D. Fisher, M. D. of Boston. 

Samuel Forry, M. D. of New York. 

E. Geddings, M. D. Professor of Sur- 
gery in the Medical College of the State 
of South Carolina. 

W. W. Gerhard, M. D. one of the 
Physicians to the Philadelphia Hospi- 
tal, Blockley. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 

R. E. Griffith, M. D. late Professor of 
Medicine in the University of Virgi- 

Thomas Harris, M. D. Surgeon U. S. 

E. Hale, M. D. Physician to the Mas- 
sachusetts General Hospital. 

Hugh L. Hodge, M. D. Prof, of Mid- 
wifery in the University of Penn. 

George Hayward, M. D. Professor of 
the Principles of Surgery and Clinical 
Surgery in Harvard University, Bos- 

Charles R, King, M. D. of New York. 

T. S, KiRKBRiDE, M. D. Physician to the 
Pennsylvania Hospital for the Insane. 

Samuel Jackson, M. D.Professorofthe 
Institutes of Medicine in the University 
of Pennsylvania. 

Samuel Jackson, M. D. Philadelphia. 

William E. Horner, M. D. Professor 
of Anatomy in the University of Penn- 

C. A. Lee, M. D. of New York. 

Valentine Mott, M. D. Professor of 
Surgery in the University of New York. 

James McNaughton, M. D. Professor 
of the Theory and Practice of Medicine 
in Albany Medical College. 

Reuben D. Mussey, M. D. Professor of 
Surgery in the Medical College of Ohio. 

T. D. Mutter, M. D. Professor of Sur- 
gery in Jefferson Medical College. 

G. W. NoRRis, M. D. one of the Sur- 
geons to the Pennsylvania Hospital. 

C. W. Pennock, M.D. one of the Phy- 
sicians to the Philadelphia Hospital, 

Thomas Sewall, M. D. Professor of 
.flnatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

Nathan R. Smith, M. D. of Baltimore. 

Thomas Stewardson, M. D. one of the 
Physicians to the Pennsylvania Hos- 

Alfred Stille, M. D. of Philadelphia, 

John A. Swett, M. D. of New York, 

A. F. Vache, M. D. of New York. 

John Ware, M. D. Professor of the 
Theory and Practice of Physic in 
Harvard University, Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

Edward Warren, M. D. of Boston. 

John Watson, M. D. one of the Sur- 
geons of the New York Hospital. 

G. B. Wood, M. D. Professor of Ma- 
teria Medica and Pharmacy in the Uni- 
versity of Pennsylvania. 

EDITOR— Isaac Hays, M. D., one of the Surgeons to Wills Hospital for the 
Blind and Lame, ^c. 


Communications have been received from Drs. Hodge, Stewardson, Earle, 
Harris, Roberts, Welcii, Wilson, Fergusson, Shipman, Wliarton, Parry, Spack- 
man and Garden. 

Tlie following works have been received: — 

On Diseases of the Bladder and Prostate Gland, with plates. By William 
Coulson. Third edition, revised and corrected. London: Longmans, & Co. 
1842. (From the Author.) 

Lectures on the Theory and Practice of Physic. By William Stokes, M.D., 
and John Bell, M.D. Second edition. In two volumes. Ed. Barrington & 
Geo. D. Haswell: Philadelphia, 1842. (From the Publishers.) 

Treatise on the Dental Art; founded on actual experience. Illustrated by 
241 figures in lithography, and 54 wood-cuts. By F. Maury, Dentist to Royal 
Polytechnic School. Translated from the French, with notes and additions, by 
J. B. Savier, D. D. S. Philadelphia: Lea & Blanchard, 1843. (From the Pub- 

A Treatise on Ruptures. By W. Lawrence, F.R. S., Surgeon Extraordinary 
to the Queen, Surgeon to St. Bartholomews Hospital, &c. From the fifth 
London edition, revised, corrected, and considerably enlarged. Philadelphia: 
Lea & Blanchard, 1843. (From the Publishers.) 

New Remedies, Pharmaceutically and Therapeutically Considered. Fourth 
edition, with extensive modifications and additions. By Robley Dunglison, 
M. D., Prof. Inst. Med. &c. in Jefferson Med. Coll., &c. &c. &c. Philadelphia: 
Lea & Blanchard, 1843. (From the Publishers.) 

Denkwiirdigkeiten aus der Medicinischen und Chirurgischen Praxis. Von 
Geo. F. Most, D. P. M. C. und G. &c. Eister Band; Leipzig, 1842. (From 
Dr. Oppenheim.) 

Beitrage zur Wissenschaftlichen Heilkunde. Von Dr. C. A. W. Richter. 
Leipzig, 1842. (From Dr. Oppenheim.) 

Bericht iiber die Ergebnisse des Therapeutischklinischen Unterrichts an der 
Kaiserlichen Medico-chirur^ischen Akademie zu St. Petersburg wahrend des 
Lehzjahres, 1839-1840. Vom Dr. Seidlitz, Prof, der Therap. Klink, &c. St. 
Petersburg, 1841. (From Dr. Oppenheim.) 

Geschechte der Gesundheit und der Krankheiten. Von Dr. Joh. Mich, Leu- 
poldt, ordentlichem Professor der Pathologic, &c. &c. Erlangen, 1842. (From 
Dr. Oppenheim.) 

Die Nahrungsmittel in ihren dietetischen Wirtungen. Bearbeitel von Dr. 
Hahn. Berlin, 1842. (From Dr. Oppenheim.) 

Annual Report of the Interments in the city and county of New York, for 
the year 1842, with remarks thereon, and a brief view of the Sanitory condition 
of the city. Presented to the Common Council, by John H. Griscom, M.D., 
City Inspector. New York, 1843. (From the Author.) 

A Practical and Theoretical Treatise on the Diagnosis, Pathology, and Treat- 
ment of the Diseases of the Skin, arranged according to a natural system of 
classification, and preceded by an outline of the Anatomy and Physiology of 
the skin. By Erasmus Wilson, Lecturer on Anatomy and Physiology in the 
Middlesex Hospital School of Medicine, and author of a system of Human 
Anatomy, with Illustrations. Philadelphia: Lea & Blanchard, 1843. (From 
the Publishers.) 

Fisk-fund Prize Dissertation of the Rhode Island Medical Society. Spinal 
Diseases, both structural and functional, their causes and treatment. By Usher 
Parsons, M.D. Boston, 1843. (From the Author.) 

An Introductory Lecture delivered before the Medical College of Georgia at 
the opening of the session, 1842-3. By Lewis D. Ford, M. D., Prof. Inst, and 
Pract. Med. Augusta, 1843. (From the Author.) 

Catalogue of the Faculty and Students of Jefferson Medical College of Phila- 
delphia. Philadelphia, 1843. 


Report of the Board of Administrators of the Charity Hospital to the Legis- 
lature of Louisiana. New Orleans, 1843. (From Dr. E. H. Barton.) 

Valedictory to the Graduates of Geneva Medical College, delivered Jan. 22, 
1843, by Frank H. Hamilton, M.D., Prof. Princip. and Pract. of Surg. Pub- 
lished by request of the class. Rochester, 1843. (From the Author.) 

Catalogue of the Trustees, Officers, and Students of the University of Penn- 
sylvania. Philadelphia, 1843. 

Fourth Annual Report of the Directors and Superintendent of the Ohio Lu- 
natic Asylum, to the forty-first General Assembly, December 9, 1842. Colum- 
bus, 1842. 

Third Annual Report of the Directors of the Maine Insane Hospital, Decem- 
ber, 1842. 

Quarterly Summary of the Transactions of the College of Physicians of 
Philadelphia. November, December, 1842, January, 1843. (From the Col- 

Transactions of the Society of Alumni of the College of Physicians and 
Surgeons of the University of the State of New York; No. 1. (From the 

Report of the Pennsylvania Hospital for the Insane, for the year 1842. By 
Thomas J. Kirkbride, M. D., Physician to the Institution. Philadelphia, 
1843. (From the Author.) 

Proceedings of the Medical Convention of Ohio, held at Cincinnati, in May, 
1842, with papers selected from those read before that body. Cincinnati, 1842. 

London Medical Gazette. Oct., Nov., 1842, Jan., Feb. 1843. (In exchange.) 

The British and Foreign Review, or Quarterly Journal of Practical Medicine 
and Surgery. January, 1843. (In exchange.) 

The Edinburgh Medical and Surgical Journal. January, 1843. (In exchange.) 

The Medico-Chirurgical Review. January, 1843. (In exchange.) 

Provincial Medical Journal. Dec, 1842, Jan., Feb., 1843. (In exchange.) 

The Dublin Medical Press. Dec, 1842, Jan., Feb., 1843. (In exchange.) 

London and Edinburgh Monthly Journal of Medical Science. Edited by 
John Rose Cormack, M. D. Dec, 1842, Jan., Feb., 1843. (In exchange.) 

Norsk Magazin for Lcegevidenskaben. Redigeret af Chr. Boeck, A. Conradi, 
Chr. Heiberg, f. Hjort, F. Hoist. Vols. 1, 2, 3, 4, and Pt. 1, Vol. 5. Chris- 
tiana, 1840, 1841, 1842. (In exchange.) 

Zeitschrift fiir die gesammte Medicin Herautsgegeben. F. W. Oppenheim. 
Aug., Sept., Oct., Nov., 1842. (In exchange.) 

Revue Medicale Fran^aise et Etrangere. July, Aug., Sept., 1842, (In ex- 

Gazette Medicale de Paris. July, Aug., Sept., Oct., 1842. (In exchange.) 

Journal des Connaissances Medico-Chirurgicales. July, Aug., Sept. Oct., 

1842. (In exchange.) 

Journal de Medecine et de Chirurgie pratiques. Aug., Sept., Oct., 1842. (In 

Journal des Connaissances Medicales pratiques et de Pharraacologie. July, 
Aug., Sept., Oct., 1842. (In exchange.) 

L'Experience, Journal de Medecine et de Chirurgie. Oct., 1842. (In ex- 

Journal de Pharmacie et de Chimie. July, Aug., Sept., Oct., 1842. (In ex- 

The Boston Medical and Surgical Journal. January, Feb., March, 1843. (In 

The Western Lancet. Dec, 1842, Jan., Feb., 1843. (In exchange.) [The 
No. of this journal for Nov., 1842, has never been received.] 

The New England Journal of Medicine and Surgery. Jan., 1843. (In ex- 

The Western Journal of Medicine and Surgery. Dec, 1842, Jan., Feb., 

1843. (In exchange.) 

The American Journal of Science and Arts. Jan., 1843. (In exchange.) 


The American Journal and Library of Dental Science. Dec, 1842. (In ex- 
The New York Lancet. January and Feb., 1842. (In exchange.) 
The American Journal of Pharmacy. Jan., 1843. (In exchange.) 
The Select Medical Library and Bulletin of Medical Science. Jan., Feb., 
1843. (In exchange.) 
The Western and Southern Medical Recorder. Jan., 1843. (In exchange.) 

The following is the statement respecting Dr. Dupre's account of the yellow 
fever of Key West, referred to in our No. for July last, and which we now feel 
called on to publish, a sufficient time having elapsed to afford Dr. D. an oppor- 
tunity of verifying his account, and of which he has not availed himself. 

We add the testimony of our esteemed collaborator. Dr. Thos. Sewall, of 
Washington, as to the entire credibility of Dr. Pinckney. 

City of Washington, May 27, 1842. 
Sir: Dr. Pinckney, the author of the following communication, has for some time 
been a resident physician at Key West, in the employment of the Government. He is 
personally and well known to me as a man of high moral and professional character. 
The most implicit confidence may be reposed in his statements. 
Very truly and respectfully yours, 

To Isaac Hays, M. D., 

Ed. of the Am. Journal of Med. Sciences. 

Key West, May 10, 18-12. 

Dear, Sir: Upon the appearance of the article on "the yellow lever at Key West, 
East Florida, by C. C. Dupre, M. D.," published in the last October No. of the Ameri- 
can Journal of the Medical Sciences, 1 felt greatly disposed to write to the editor of 
that journal, and inform him, that the author of that article has availed himself of the 
remote and isolated situation of this island, and the consequent apparent immunity 
from exposure, to impose upon the editor and medical profession. But not having the 
honour of a personal acquaintance with the editor of that journal, a little reflection 
induced me to abandon the idea of writing to him, lest he might apprehend that my 
efforts to expose one imposture was but the attempt to practice another. But when you 
were pleased to urge me to communicate with you on the subject, I had no longer any 
excuse for deferring what had then become a duty to my profession. 

The wrtier of this article says, "On my arrival here (Key West) in May last," «&c., 
and "early in June I was called upon to visit a seaman, who had been sent ashore 
from a vessel in the harbour," &,c., and whom he says he found sick of the "yellow 
fever of Cuba," and from whom he took "forty ounces of blood," and administered to 
him "thirty ounces of olive oil in three doses during the first three hours," and "per- 
mitted him to drink as nmch pine-apple water as he thought proper," &c. &c,, giving 
detailed and minute accounts of cases, his visits, treatment, &c. Now, not a single 
case of yellow fever appeared on this island until the twenty-second day of June, and 
during the whole period of its continuance, having been a resident physician here for 
some years, I believe I visited every case that occurred: this I could easily do, as the 
entire population at that time did not exceed 450 souls, and was collected tqgether in a 
little village. I neither heard nor saw anything of Dr. Dupre at that time, nor 
since, except in the Medical Journal. No one here, that I have conversed with, ever 
saw or heard of him; and it is believed that no physician from abroad visited this 
island during the prevalence of the yellow fever last summer. I cannot conceive how 
or where the Doctor so effectually concealed himself and his patients as to elude the 
observation of the entire population of a little village, in which every other stranger is 
at once noticed and observed. One would naturally suppose, that with his "olive and 
almond oils," his *' pine-apple water," his "anti-mercurial treatment," and, above all, 
his great success in practice, that he would have become the lion and oracle of the little 
village. Of the causes which operated in producing the yellow fever here last summer, 
I may perhaps hereafter, and when I have more leisure, write you. But at present I 
only intend to notice a single one of the causes assigned by Dr. Dupre. He says, " vast 
quantities of sea-weed were deposited upon the beach, and its decomposition was as- 
signed as one of the causes of the disease." It is believed that this deposit of sea- weed 



was no larger during the last than previous summers. Sea-weed is being constantly 
thrown upon our shores, and its decomposition is all the while going on; and yet it has 
never been regarded here, either by the profession or laity, as contributing to the pro- 
duction of disease. The marvellous phenomenon of " myriads of flics dead upon the 
shores," which he mentions as increasing the apprehension of the citizens of a sickly 
season, is the mere figment of a creative wonder-working fancy. No such treatment 
as that indicated by Dr. Dupre was adopted in any case of yellow fever occurring on 
this island during the last summer. Neither "olive nor almond oil," nor "pine-apple 
water," nor the " anti-mereurial treatment" was employed either by physician or pa- 
tient in a single instance. On the contrary, the treatment adopted was that recom- 
mended by our standard authors — bleeding freely in the forming and first stages of the 
disease, active cathartics, and the employment of such other remedies as the symp- 
toms indicated. This course of treatment is believed to have been quite as successful 
as could have been expected under the circumstances, 

I regret that the multiplicity of my engagements have prevented, for so long a time, 
my complying with your request, to write you upon the subject of this article, from 
Dr. Dupre; and now prevent, for the present, my writing you niy opinions of the 
causes which produced the late epidemic on this island, its characteristic features, and 
the treatment employed by me. 

With high regard I am, sir, very respectfully, your obedient servant, 


To Thomas Sewall, M. D,, Washington. 

Communications intended for publication, and Books for Review, should be 
sent, free of expense, directed to Isaac Hays, M. D., Editor of the Amer. Journ. 
of Med. Sci., care of Messrs. Lea & Blanchard, Philadelphia. Parcels directed 
as above, and sent (carriage paid) under cover, to John Miller, Henrietta Street, 
Covent Garden, London, or to Wiley & Putnam, Neiv York, or W. D. Ticknor, 
Boston, will reach us safely. We particularly request the attention of our 
foreign correspondents to the above, as we are often subjected to unnecessary 
expense for postage and carriage. 

All remittances of money, and letters on the business of the Journal, should be 
addressed exclusively to the publishers, Messrs. Lea & Blanchard. 

0;y^ The advertisement sheet belongs to the business department of the 
Journal, and all communications for it should be made to the publishers, 
under whose exclusive control it is. 





APRIL, 1843. 



I. External Iliac Aneurism successfully treated by ligature to the Common 
Iliac Artery. By Edward Peace, M. D., one of the Surgeons of the 
Pennsylvania Hospital. -..- 2G9 

II. On the Active Principle of Malaria. By Daniel P. Gardner, M. D., 
Professor of Chemistry, &c. in Hampden Sidney College, Va., &c. - 279 

III. Excision of the Olecranon Process for Anchylosis of the Elbow-joint. By 
Gurdon Buck, Jr., M.D., one of the Surgeons of the New-York Hospital. - 297 

IV. Electro-Magnetism in a case of Poisoning — with suggestions for its 
application to still-born Children, and to some forms of disease. By 
Thomas S. Page, M. D., of Valparaiso. 301 

V. Analysis of a Substance represented to be Pulverized Cubebs. By 
William Procter, Jr. 306 

VI. Disease of the Heart. Hypertrophy and dilatation of the Auricles and 
right Ventricle; hypertrophy of the left Ventricle; cartilaginous thicken- 
ing of the Mitral Valve; contraction of the chordae tendines connected 
with it; permanent patescence and regurgitation through the left auriculo- 
ventricular orifice; thickening of the tricuspid valve; Endopericarditis; 
Pulmonary Apoplexy. Death. Autopsy. With remarks. By C. W. 
Pennock, M. D., Attending Physician of the Philadelphia Hospital, 
Blockley. 309 

VII. On the use of the Liquor of Hydriodate of Arsenic and Mercury in 
Cutaneous and Uterine Affections. By Isaac E. Taylor, M. D., of New 
York. 319 

VIII. Obstetrical Cases and Observations. By Isaac G. Porter, M. D., of 
New London. 325 

IX. Communication of Pulmonary Air Vesicles by a direct route with the 
Pulmonary Veins. By W. E. Horner, M. D., Professor of Anatomy in 

the University of Pennsylvania. 332 

X. Surgical Cases. By Geo. Fox, M. D., one of the Surgeons to Wills 
Hospital. 335 

XI. Observations on the Pulse and Respiration. By John M. B. Harden, 

M. D., of Liberty county, Georgia. 340 

XII. On the Curability of Insanity. By Pliny Earle, M. D. - - - 344 
XIH. Luxation of the Patella on its Axis. By Joseph P. Gazzam, M. D., 

of Pittsburg, Pa. - - - - 363 



XIV. Case of Salaam Convulsion, with Remarks. By Ezra P. Bennett, 
M. D., of Danbury, Conn. 364 

XV". Case of Medullary Sarcoma of the Labia, and other cases of Malignant 
Disease, with Remarks. By A. B. Shipman, M. D., of Cortlandville, 
New York. 368 

XVI. Incontinence of Urine, successfully treated by Nitrate of Potash. By 

J. Young, M. D., of Chester, Delaware County. - - - . _ 371 


XVII. Notes and Observations on the Ionian Islands and Malta: With 
some remarks on Constantinople and Turkey, and on the System of 
Quarantine as at present conducted. By John Davy, M. D., F. R. SS. 
L. & E. Inspector-General of Army Hospitals, L. R. London: 2 vols. 
8vo., pp. 936. 373 

XVIII. Nouvelles recherches sur plusieurs poisons tires du regne mineral. 
Par M. Orfila. — Annales d'hygiene, No. 55, Juillet, 1842. Recent re- 
searches in relation to several Poisons derived from the mineral king- 
dom. By M. Orfila. 392 


XIX. A System of Practical Surgery. By William Fergusson,F.R.S.E.; 
Professor of Surgery in King's College, London, Surgeon to King's Col- 
lege Hospital, &c. &c., with 246 Illustrations, from drawings by Bagg, 
engraved by Gilbert. With notes and additional illustrations, by George 
W. Norris, M. D., Surgeon to the Pennsylvania Hospital. Lea & 
Blanchard, 1843, pp. 629, 8vo. 405 

XX. Observations on the admission of medical pupils to the wards of Beth- 
lehem Hospital, for the purpose of studying mental diseases. By John 
Webster, M. D., one of the Governors. 3d edition. London, 1842, pp. 

62, 8vo. - 416 

XXI. Treatise on the Dental Art, founded on actual experience. Illustrated 
by two hundred and forty-one figures in lithography, and fifty-four wood, 
cuts. By F. Maury, Dentist of the Royal Polytechnic School. Translated 
from the French, with notes and additions, by I. B. Savier, Doctor of Den- 
tal Surgery, pp. 293. Philadelphia, Lea & Blanchard, 1843. - - 118 

XXII. A Treatise on Ruptures. By W. Lawrence, F. R. S., &c. From 
the fifth London edition, revised, corrected, and considerably enlarged. 
Philadelphia, 1843. 419 

XXIII. Elements of Materia Medica and Therapeutics. By Jonathan Pe- 
reira, M. D., F. R. S. & L. S., &c. &c. &c. With numerous illustrations. 
From the second London edition, enlarged and improved. With notes 
and additions, by Joseph Carson, M. D., Professor of Materia Medica and 
Pharmacy in the Philadelphia College of Pharmacy, and one of the 
Editors of the American Journal of Pharmacy: 2 vols. 8vo. Philadelphia, 
Lea & Blanchard, 1843, pp. 714 and 800, 8vo. - - - . - 421 

XXIV. General Therapeutics and Materia Medica, adapted for a Medical 
Text Book. By Robley Dunglison, M. D., Professor of Institutes of 
Medicine, &c. in Jefferson Medical College of Philadelphia, &c. 2 vols. 
Svo. Philadelphia, Lea & Blanchard, 1843, pp. 515 and 489. - 421 

XXV. Quarterly Summary of the Transactions of the College of Physicians 

of Philadelphia, Nov. and Dec. 1842, and Jan. 1843. - - - - 422 

XXVI. 1. Annual Report of the Board of Trustees of the Massachusetts 
General Hospital, for the year 1842. Boston, 1843, pp. 37. 

2. Third Annual Report of the Directors of the Maine Insane Hospital. 
December, 1842, pp. 51. 




3. Fourth Annual Report of the Directors and Superintendent of the Ohio 
Lunatic Asylum, to the 41st General Assembly. December, 1842, pp. 88. 424 

XXVII. The Northern Lakes a Summer Residence for Invalids of the 
South. By Daniel Drake, M. D., Professor in the Medical Institute of 
Louisville. Louisville, 1842, pp. 29, 8vo. 427 

XXVIII. Report of the Pennsylvania Hospital for the Insane, for the year 
1842. By Thomas S. Kirkbride, M. D., Physician to the Institution. 
Philadelphia, 1843, pp. 50, 8vo. 429 

XXIX. The Diseases of Females, including those of Pregnancy and Child- 
bed. By Fleetvi^ood Churchill, M. D., Licentiate of the King and 
Queen's College of Physicians in Ireland — Physician to the Lying-in 
Hospital, and to the Adelaide Hospital — Lecturer on Midwifery, and 
Diseases of Women and Children, in the Richmond Hospital School of 
Medicine, &c. Second American edition, with Notes, by Robert M. 
Huston, M. D., Prof, of Materia Medica and General Therapeutics, and 
formerly of Obstetrics and Diseases of Women and Children, in Jeffer- 
son Medical College, Philadelphia. Physician to the Lying-in Depart- 
ment of Philadelphia Hospital, &c. &c. Philadelphia, Lea & Blanch- 
ard, 1843. 430 





Anatomy and Physiology. 

1. On Menstruation. By M.Brierre 

de Boismont. - - - - 431 

2. Relation of the Fallopian Tubes 
to the Ovary in the Mammalia. 

By M. Raciborski. - - - 432 

3. Researches on Digestion. By 
MM. Bouchardat and Sandras. 432 

4. Decussation of Fibres at the 
base of the Brain. By M. Fo- 
ville. 434 

5. Termination of Nerves. By M. 
Mandl. 434 

6. Structure of the Nervous Sys- 
tem. By M. Mandl. - - 435 

7. Development of Bone. By M. 

8. Precocious Menstruation in a 
Girl two years old. By Dr. Ca- 
rus. - - _ . - 

9. Third Dentition. - - - 

10. Man with three Testicles. By 
Dr. F. Macann. - ' - 

11. Origin of Fibre — Structure of 
Fibrine and of False Membranes. 
By Mr. Gulliver. - 

12. Existence of Lymphatics in 
pseudo-membranes. By Mr. 
Hamilton. - - - - 

- 435 





Materia Medica and Pharmacy. 

13. Elective action of Medicines. 

By M. Coze. - - - - 438 

14. Absorption of Medicinal Sub- 
stances. By M. Mialhe. - 438 

15. Abuse of Purgatives. By Drs. 
Samuel Rogers and Alex. Lori- 
mer. 439 

16. Liquor Taraxaci. - - -439 

17. On the Preparations of the 
Citrate of Iron. By M. Mialhe. 439 

18. New Alkali extracted from 
Quinquina. By M. Manzini. - 440 


Medical Pathology and Therapeutics and Practical Medicine. 

19. Frequency of a second attack 

of Smallpox. By M. Serres. -440 

20. On Abnormal Nutrition (com- 
monly called Inflammation), and 
on the mode in which its differ- 
ent Products are developed, as 
Softening, Suppuration, Granu- 
lation, Reorganization of Tissue, 
Morbid Growths, &c. &c. By 
Dr. J. H. Bennett, - - - 441 

21. Researches into the composi- 
tion of the Blood in Typhus Fe- 
ver. By M. de Renzi. - - 443 

22. State of the Blood in Scurvy. 

By Dr. Budd. - - - - 443 

23. Cyanosis from a rare Mal- 
formation of the Heart. By 
James Douglas, Esq. - - 444 

24. Chorea resulting from Pericar- 
ditis. By Dr. Favell. - - 445 

25. Disease of the Heart. By Dr. 
Favell. 446 

26. Epidemic Croup which pre- 
vailed in 1840, and at the begin- 
ning of 1841, in the Hopital des 
Enfans, at Paris. By M. E. 
Boudet. 446 

27. Irritability of the stomach pro- 
duced by eating wheaten flour. 

By M. David. - - - - 448 

28. Nervous Asthma. By M. Du- 
cros. 448 

29. Spontaneous perforation of the 
Stomach. By M. Lefevre. - 449 

30. Conversion of Nerves into fat. 
Miiller. 449 

31. Diabetes Mellitus cured by 
Hydrochloric Acid. ByDr. Gen- 
naro Festeggiano. - - - 449 

32. Pulmonary Consumption in 
Man and Animals. By M. Rayer. 449 

33. On Primary Syphilitic Bu- 
boes. By M. de Castlenau. - 451 

34. Tubercular Deposits in the 
Bronchial Glands. By Drs. Ril- 
liet and Barthez. - - - 452 

35. Tic Douloureux cured by re- 
peated blistering. By M. D. 
Valleix. 452 

36. Diagnosis of granular degene- 
ration of the Kidney. By Dr. 

C. Haller. - - - -452 

37. Bright's kidneys without albu- 
minous Urine; albuminous Urine 
without Bright's kidneys. By 
Dr. Graves. - - - - 453 

38. Proto-ioduret of Iron in Con- 
sumption. By M. Gilbert Bois- 
siere. - . - - - 454 

39. Concrete Naphthaline in Pso- 
riasis. By Dr. Emery. - - 455 

40. Causes of sudden death. By 

M. G. Tourdes. - - - 455 

41. On the Causes and Treatment 

of Goitre. By M. Pascal. - 456 

42. New Mode of arresting Epis- 
taxis. By M. Negrier. - - 456 

43. Geological causes of Hill Fe- 
ver in India. By Dr. Heyne. - 457 

44. Report on the results of Inocu- 
lation in Measles. By Dr. M. 
Von Katona. - - - - 458 

45. Hairs growing on the Tongue. 

By Dr. Beer. - - - - 458 

46. The relative frequency of Tu- 
bercles in various organs. By 

Dr. Engel. - - - - 458 

47. Epidemic Cerebro-Spinal Me- 
ningitis, observed at the Medical 
Clinique of the University of 
Strasburg. By Prof. Forget. - 458 

48. Warty excrescence of the La- 
rynx. By Dr. Fletcher. - - 460 

49. Hemiplegia from tying the 
Common Carotid Artery. By 

M. Sedillot. - - - - 460 

50. Ossification of the Diaphrara 
and Partial Aphonia. By James 
Pagan, Esq. - - - - 450 

51. Observations on Tubercle of 
the Brain in Children. By P. 
Hennis Green, M. B. - - 461 

Surgical Pathology and Therapeutics and Practical Surgery 
By M. 

52. Dissecting Aneurism. 
Tessier. - - - - - 

53. Dislocation of the Knee. 

54. Compound Fracture of the Leg 
— reunion interrupted by Gesta- 
tion. By R. H. Oswald, Esq. 

55. Varicose enlargement of the 
external abdominal Veins. By 
T. B. Peacock, Esq. 




56. Gun-shot wound of the Shoul- 
der-joint treated by excision of 
the Humerus. By P. T. H. 
Baddely. - - - - - 467 

57. Successful Amputations at the 
Shoulder-joint. By Dr. Hous- 
ton. - - - - - 469 

58. Erectile Tumour in the Ham. 469 

59. Bony Union of the neck of the 




Femur within the Capsule. By 
Robert Hamilton, Esq. - - 470 

60. Dislocation of the Ankle — Ti- 
bia outwards, without fracture 
of either malleolus. By Edward 
Parker, Esq. - . - - 470 

61. Dislocation of the lower end of 
the Ulna forwards. By Mr. 
Parker. - - - - - 470 

62. Reunion of Fractured Femur 
at an advanced age. By Dr. W. 

F. Henderson. - - - 471 

63. Local Treatment of Chancres 
by Sulphate of Copper and Cy- 
anuret of Mercury. Bv Dr. 
Strohl. - - - ■'- - 471 


64. Nitrate of Silver in bed sores. 

By Mr. Henry Jackson. - - 471 

65. Stricture of the Urethra. By 

M. Cruveilhier. - - - 471 

66. Abscess of the Brain. By M. 
Aran. 472 

67. Lardaceous Tumours of bone. 

By Mr. Hodgson. - - - 472 

68. Fracture of the Clavicle with- 
out displacement. By M. Blan- 
din. 473 

69. Dislocation of the Forearm 
backwards. By M. Roux. - 474 

70. The Starch Bandage. By M. 
Lisfranc. - - - - 474 


71. Tumours of the Eye and Orbit, 
protruding the Eyeball. By Dr. 
Jacob. ----- 475 

72. Vascular bleeding Tumour of 
the Cornea. By Dr. Jacob, - 476 

73. Remarkable appearance in an 
amaurotic Eye. By Dr. Jacob. 476 

74. Asthenic Amaurosis cured by 
the use of convex Spectacles. 

By Dr. Cunier. - - - 477 

75. Double Cataract, complicated 
in right eye apparently with 

Amaurosis — extraction of lenses 
— restoration of sight of right 
eye. By Mr. Walker. 

76. Injury of right eye — sympa- 
thetic Ophthalmia of the left — 
complete loss of vision — restora- 
tion by operative means. By 
Mr. Walker. - - - - 

77. Improved method of extirpat- 
ing the eye. By Dr. Bonnet. - 

78. Foreign substance in the Eye. 
By M. de Castelnau. 

- r. 





79. Apparent death of the fcRtus in 
utero. By Samuel Hare, Esq. - 481 

80. Twins — interval of two months 
between their births. By Mr. J. 

T. Vale. 482 

81. Death by Hemorrhage from a 
varix of the left labium. By Dr. 
Hesse. 483 

82. Death from bursting of a varix 
in the thigh of a pregnant wo- 
man. By Dr. Killer. - - 483 

83. Caesarian Section successfully 
performed. By Dr. Merrem. - 483 

84. Diagnosis of some obscure af- 
fections of the Uterus. By M. 
Pereyra. 483 

Medical Jurisprudence and Toxicology. 


85. Death after a blow — Bursting 
of an Aneurism. . - . 

86. Detection of Arsenic, &c., in 
Organic Mixtures. - - - 

87. Non-conversion of Calomel in- 
to Corrosive Sublimate by the 
alkaline chlorides. By Lepage. 

88. Presumption of Survivorship. 

89. New mode of detecting arse- 




nic. By Mr. Bevan. - - 492 

90. Poisoning by Antimony By 

M. Flandin. - - - - 493 

91. Death from the introduction of 
needles into the Heart. - - 493 

92. Death from a large dose of 
Sulphate of Quinine. - - 494 

93. Cases of poisoning by Sau- 
sages. By Dr. Roeser. - - 494 


94. Composition of confined air. 
By M. Felix Leblanc. 

I 95. Open Foramen Ovale in an 
495 1 adult. By H. J. Johnson. -49 6 




Of a new knife for dividing the 
stricture in cases of Strangulated 
Hernia, so constructed as to pre- 
vent the lesion of any other parts 
than those constituting the stric- 
ture. By T. Campbell Stewart, 
M. D., [with a wood-cut.] - 497 

Fatal Singultus following the bite 
of a rabid dog. By W. L. Whar- 
ton, M. D. - - - - 498 

Case of Premature Birth. By A. 
B. Shipman, M. D. - - - 499 

Case of remarkable Precocity in 
a Male. By A. Lopez, M. D. - 500 

Trial of Charlotte Hamblin, alias 
Charlotte Ewing, for the murder 
of Andrew W. Ewing. - - 501 

Rupture of the Spleen. By Dr. A. 
G. Welch. - ... - 503 

Cataract operated on at a very ad- 
vanced age. By Dr. Wm. M. 
Boling. 503 

Singular case of congenital de- 
formity. By Samuel Lilly, M. D. 503 

Annual Report of the Obstetric 
Practice in the Philadelphia 
Dispensary for the year 1842. 
By Joseph Warrington, M. D., 
Obstetric Physician. 

Statistics of Pulmonary Consump- 
tion in the cities of Boston, New 
York and Philadelphia for thirty 
years. By George Hayward, 
M. D. 

National Institute. — Medical De- 
partment. — Circular. 

Fictitious Jalap. - 

Gun-shot wound of the Face and 
Neck — Ligature of the Carotid 
Artery. By Dr. Twitchell. 

Luxation of Cervical Vertebrae. 
By Prof. Horner. - 

New works on Chemistry. By 
Dr. J. W. Webster. - - 

Medical Society of Virginia — Prize 
Essay. - . - - - 










Page 55, line 36 from top, for " five" read two. 

56, lines 4 and 5 should be transposed to top of page. 
71, line 25 from top, for " regore" read regorge. 
76, note, line 7 from bottom, for " rouge" read ronge. 
317, line 6 from bottom, dele " much." 





APRIL, 1843. 

Article I. — External Iliac Aneurism successfully treated by ligature to 
the Common Iliac Artery. By Edward Peace, M. D., one of the Sur- 
geons of the Pennsylvania Hospital. 

Israel Jones, a bricklayer, a^ed 36, of healthy parents, a moderate drinker, 
with a remarkably strong constitution and large powerful frame, was admit- 
ted into the Pennsylvania Hospital the 22d day of August, 1842, with an in- 
guinal tumour on the right side. Owing lo the difficulty of procuring 
employment at his trade for the last two years, he had been engaged at the 
quarry at Leiperville in loading vessels with st n^. About five months 
since, he perceived a small hard tumour, unattended with pain, of the size of 
a filbert, in his right groin, where he had felt something give way ten days 
before, whilst lifting a heavy stone for a wager. He, however, paid no 
attention to it for three weeks, when he found it had already attained the 
size of a walnut, and was rapidly enlar itH.r and could be seen and felt dis- 
tinctly pulsating. About the beginning of the third month he first began to 
feel occasionally, and usually after severe exercise, or after the labour of the 
day, pain in the affected part and shooting along the front of the thigh; he 
had also considerable numbness along the course of the crural nerve; this 
sensation, like that of pain, was always produced as well as aggravated by 
exercise, and equally soon dissipated by rest and flexion of the limb. During 
the progress of the disease he contrived to work, till a fortnight since, when 
the sensibility of the tumour inei eased to such a degree, that he has been un- 
able to rest in any other than a silting posture, with his right leg in the posi- 
tion recommended by Pott for fractured thigh, that is, flexed and resting on 
the outside, to diminish as much as possible the tension in the groin. During 
the last week he experienced loss of appetite and inability to walk, or to 
sleep on account of the severity of the pain. Anodynes have been freely 
No. X.— April, 1843. 18 

270 Peace's Ligature of Common Iliac Artery, [April 

taken, without however producing any relief. Cold water alone, afforded 
the slightest mitigation to his sufferings. He applied to two medical gentle- 
men, who recommended liniments and hot poultices. He then came under 
the observation of Dr. Griffith, a highly respectable physician in the northern 
part of the city, who immediately detected the true nature of the disease, and 
recommended him to be placed under my care. He had undergone no con- 
stitutional treatment further than a reduction of diet and entire abstinence 
from animal food for a few days anterior to his reception into the hospital. 

Upon examining the patient on the following day, we found that an opiate 
had procured him short intervals of sleep, which had considerably refreshed 
him, and he expressed himself as having had a more comfortable night than 
he had experienced for some weeks. He is pale, but not much emaciated, 
still very muscular, has lost some strength, his appetite moderately good, 
and in other respects his general health is not seriously impaired. 

The tumour is red, injected and elastic, and is very sensitive to the slightest 
pressure; it is hard, and particularly so at its lower portion, and expands and 
contracts at each pulsation with considerable force, and equally in every di- 
rection, the wave can be felt three inches below its lower margin. Pressure 
upon the aorta quiets the aneurismal throb and completely checks the flow 
of blood, and also diminishes sensibly the volume of the tumour. The aneu- 
rismal thrill is but faintly heard. The pulsation of the popliteal and an- 
terior tibial arteries can be felt, but less strongly than those of the other 
side. No marked diminution can be detected in the size of the right limb, 
the sensibility of which is natural. The tumour is of an irregular pyriform 
shape, extending in length from three inches below, to three inches above 
Poupart's ligament, and in breadth, five inches from the anterior superior 
spinous process of the ilium to within an inch and a half of the median line, 
and to about the same distance above the crest of the pubis. The tumour 
(the greatest transverse diameter of which is at the upper part) is divided into 
two portions by a shallow depression, caused by the tension of the fibres of 
Poupart's ligament, which have yielded but slightly to the pressure. The 
tumour dips deeply into the pelvis, involving a considerable portion of the 
external iliac, but to what extent it is impossible now to ascertain. The patient 
has a very anxious countenance, complains much of pain in the knee, and 
has severe paroxysms of spasm in the calf of his leg. 

By perfect rest and keeping him on a regulated diet, and application of equal 
parts of laudanum and water for four days, all the local symptoms have mode- 
rated; and with the exception of total loss of sleep, the patient is much more 
comfortable. A consultation of the surgeons of the house was held, and it 
was determined to apply on the following day a ligature above the tumour. 
Upon representing to the patient the nature of the disease, the difficulty of 
the operation, and the uncertainty of the result, he cheerfully submitted to be 
governed entirely by our advice. Ordered an ounce of castor oil immediately. 
Eighty drops of laudanum to be given two hours previous to 11 o'clock, the 

1843.] Peace's Ligature of Common Iliac Artery, 271 

hour appointed for the operation; an enema to be administered at the same 
time. The patient was requested to abstain from all nourishment during the 
morning, so as to guard as much as possible against protusion of the intes- 
tines, which had complicated so seriously many of the previous operations. 
By these precautions we were enabled by pressing upon the aorta to com- 
mand entirely the flow of blood through the tumour, which would have been 
of great importance in case of any hemorrhage during the operation. 

The patient having had his groin shaved, and placed upon a table of a 
convenient height, on the morning of the 29th of August, before the medi- 
cal class, assisted by my colleagues, Drs. Randolph and Norris, and the ex- 
perience of Dr. J. Rhea Barton, I proceeded to make an incision seven inches 
in length through the integuments, commencing at a point, on a level with 
the umbilicus, two inches within, and three inches above the anterior supe- 
rior spinous process of the ilium, and approaching to within an inch of 
Poupart's ligament, and terminating one half an inch above the external 
ring; this divided the arteria ad cutem, which was twisted by the artery for- 
ceps, no ligature was required; next the superficial fascia was divided, then 
the tendon of the external oblique was exposed, nicked, and with the aid of 
a director, was cut the whole length of the first incision as far inwards as the 
spermatic cord. There was considerable difficulty in raising up the lower 
edge of the tendon of the internal oblique and transversalis, owing to the 
thickening and induration of the surrounding tissues from the pressure of the 
tumour; this was finally accomplished by means of the handle of the knife, 
and a careful division of the layers as they presented themselves, until we 
arrived at the peritoneum, having cut some of the, fleshy fibres of the trans- 
versalis; the peritoneum was then carefully and with some difficulty detached 
from the tumour, which was found to involve a great portion of the external 
iliac artery; we continued raising the peritoneum till we came to a part of the 
artery which appeared to be healthy, this was about one half an inch above 
the bifurcation of the common iliac. The artery was separated from the 
vein by the finger nail, and a silk ligature was passed underneath from with- 
in outwards, by means of the admirable aneurismal needle of Professor Gib- 
son. Notwithstanding the precautions that we had taken to have the bowels 
"well evacuated, and the length of our first incision, it was some time before 
we were able to get a view of the curve of the needle still held under the 
artery, on account of the projection of the tumour and the protusion of the 
abdominal contents. Finally by means of broad curved steel spatulas, and 
drawing forward the artery by means of the aneurismal needle that was under- 
neath, we managed to get a view of the common iliac artery, and the iliac 
vein underneath, on the side of the sacro-vertebral promontory, with the 
ureter crossing the artery, and attached to the raised peritoneum. The liga- 
ture was without the slightest difficulty passed out of the wound by the watch 
spring of the needle, and was tied by the tips of the fingers with a simple 
double knot; both ends of the ligature were allowed to remain hanging to- 

272 Peace's Ligature of Common Iliac Artery, [April 

gether from the wound. Immediately the pulsation of the tumour ceased, 
and its volume sensibly diminished. The edges of the wound were brought 
together by three interrupted sutures and adhesive plaster, and dressed with 
lint spread with cerate, and retained by two adhesive strips. The patient was 
removed to his bed, placed on his back, his leg slightly raised by a pillow 
under the knee, his shoulders raised, his body flexed and inclined towards the 
afl^ected side. The needle was placed under the ariery in seventeen minutes, 
but thirty minutes more were required before the patient was removed to his 
bed. He bore the first steps of the operation well, without a murmur, but 
the manipulation required to get a view of the exact position of the ligature 
gave great pain, and produced excessive nervous prostration. Wine and 
water were freely given, and in an hour afterwards considerable reaction 
had taken place. Pulse 92; previous to the operation it was 84. Skin warm 
and moist, entire insensibility below the middle of the thigh, and getting cold. 
Limb to be enveloped in carded wool. 

3 P. M. Pulse 92; thigh and leg warmer; numbness and insensibility 
complete below the knee. Temperature at the knee of the affected side 92° 
Fahr., at the foot 82°; of opposite limb 94°. Some fulness of saphena vein, 
with slight (edema of foot. Gentle frictions with the hand, especially to the 
foot and toes; in three hours time the leg was warm to the ankle; numbness 
of leg and foot gone, and sensibility slightly returned; no alteration of pulse; 
pain at the sole of the foot. 

12 P. M. Pulse 92; soft and easily compressed; no thirst; no urination; 
limb warm as far down as the toes, sensibility restored to the instep; in good 
spirits, and thinks he will sleep, as he is now, for the first time for weeks, 
free from pain. Ordered barley water, and sol. morph, 5iij. 

2S//«, 10 A. M. The morphia had to be repeated during the night; restless 
during the early part of the night, but towards morning slept five hours and 
awoke much refreshed, with the anxious expression of face gone; pulse 92, 
soft; tongue clean; skin moist; copious urination. Temperature of leg natu- 
ral, of toes 84°, and their sensibility evidently returning; no pain in tumour, 
and very slight uneasiness in wound. Towards evening the pulse rose to 
96, full, but soft and compressible, with some numbness of leg and burning 
of the foot and toes, which were much relieved by gentle frictions; removed 
the carded wool, keeping only the toes enveloped. Iced toast water during 
the day, and sol. morph. 3iij. at night. 

29^/i. Passed a comfortable night; pulse 92; skin moist; appetite good; no 
uneasiness at tumour or wound; fulness of saphena vein gone; numbness yet 
of toes, with some heat in foot, but no material pain; these uneasy feelings 
were readily relieved by friction of the hand; temperature of toes 84°; in the 
afternoon a natural dejection; anxious for nourishment; continues his drinks, 
and morphia to be given in case of inability to sleep. 

30//i. No sleep, till the administration of the third of a grain of morphia; 
then passed a comfortable night, but awoke not feeling well; pulse 92; skin 

1843.] Peace's Ligature of Common Iliac Artery, 273 

dry; some thirst; no appetite; no urination for sixteen hours; fubiess above 
the pubis, with some pain; ordered a common enema and a warm cataphism 
over hypogastric region. The enema produced a natural evacuation, wliich 
was soon followed by relief of the retention of urine; the skin became moist; 
thirst gone, and appetite returned. Sol. morph. 3ii. 

31sf. Slept the whole night; pulse 92; pain in right knee, with some 
numbness; temperature of toes 84°; dry friction every two hours; removed the 
dressing; found that the wound had united by the first intention, in rather more 
than one-third of its length internally, suppuration moderate, and of a healthy 
character. The tumour has sensibly diminished; firmer, widi its surface free 
from discoloration, the capillary circulation of leg and foot still sluggish. 

Sept. 1st. Slept well; pulse 84; skin moist; less pain of knee than yes- 
terday. Temperature of right thigh 95°; warmer than the left, which is 93°; 
toes 88°; capillary circulation entirely restored throughout the affected limb; 
dejections daily without the aid of enema; diet, tea and toast in the morning, 
and rice and molasses at dinner. On the afternoon of the next day, the leg 
was swollen below the knee, and not sensitive to pressure; pain shooting up 
from toes to knee. Limb directed to be elevated and kept uncovered during 
the night. Sol. morph. ^ij. 

3cL Slept well; pulse 80; leg less swollen and cooler; toes for the first 
time of a natural temperature. The tumour is now swollen, with heat and 
redness at its summit, more than one-half of the wound has united; the sup- 
puration trifling; slight flush along the edges, especially near the ligature, 
removed one suture, and directed a lotion of lead water. 

4th. Rested well; tumefaction diminishing in the leg and tumour, which 
is less painful and cooler; continue the lead water. The following day there 
was some return of the pain at the knee, and of the swelling, which were 
relieved by elevation of the limb, and frictions with soap liniment. On the 
next day the remaining sutures were removed, and he continued to im- 
prove till the morning of the 7th, when we found that he had been unable to 
sleep the previous night, and had changed his position from tlie right to the 
left side; is now suffering from intense pain of a throbbing character in the 
tumour, which is hot, red and swollen, without, however, any constitutional 
symptoms. In a few hours these somewhat alarming symptoms were re- 
lieved by repeated applications of lint saturated with laudanum. 

Sth. The swelling nearly gone; pain severe, but much less than yes- 
terday; tumour less inflamed, and decidedly firmer and smaller; continue 
the laudanum dressing, which gives great comfort to the patient. These un- 
pleasant symptoms were probably brought on by the imprudence of the 
patient, as his attendants find it difficult to convince him of the importance 
of remaining quiet, still more to cause him to respect their directions. The 
wound is now closed with the exception of the sinus occupied by the liga- 
ture; the suppuration trifling, barely sufficient to soil the dressing; nothing 
occurred further worthy of recording, till the thirty-second day, when the 

274 Peace's Ligature of Common Iliac Artery* [April 

ligature was evidently loose, and three days afterwards it came away. The 
noose was covered with plastic lymph and of a small size, showing it to have 
been tightly tied. • 

On the fourth day after the removal of the ligature, we found the patient 
walking about his room; the discharge from the sinus slight, the orifice of 
which is surrounded by large flabby granulations, which were allowed to re- 
main undisturbed to pi event the external orifice from closing. 

Oct. Sth. Leaves the hospital to day for home, against our advice. The 
sinus is now filled up — the large granulations cauterized. There has been a 
progressive diminution in the bulk of the tumour, which is now less than one- 
half of its original size, and free from all pain. No return of pulsation in the 
popliteal or tibial arteries. The only artery that can be felt pulsating is the 
pedial, and that very faintly.* 

23d. Walked four miles to see me — wound cicatrized, tumour smaller 
and perfectly hard — a few days after this, he very imprudently engaged to 
load a vessel with stone, but at the end of the job he experienced some pain 
in his right groin, which obliged him to desist from work for some days, 
since which, he has remained well. 

Feb. 1st, 1843. I had the pleasure of seeing to-day, five months since the 
operation, the patient who presented himself at the Hospital for examination. 
The tumour is now of the size of a filbert, situate a little above Poupart*s liga- 
ment. The line of incision has kept pace with the contraction of the integu- 
ment over the tumour, and the cicatrix is only three inches in length. He is 
now able to provide for his family, and is in the enjoyment of robust health. 

Remarks. — For reasons which have been given at length in an account 
of a case of inguinal aneurism, operated on by me in Oct. 1841, (see this 
Journal for Jan. 1842, page 250,) no more time was allowed to elapse than 
was necessary to reduce the local symptoms produced by the removal of the 
patient to the hospital before an operation was resorted to. 

After the immediate effects of the application of the ligature were over, we 
were struck with the mildness of the symptoms. With the exception of the 
spasmodic stricture of the fourth day (which according to Sir Astley Cooper 
is a very common symptom after operation for inguinal aneurism), and the in- 
flammation of the tumour on the tenth day, which appeared to be brought on 
by the imprudence of the patient, very little treatment was required, and we 
had only to wait patiently for the separation of the ligature. Many surgeons 
recommend the application of a small ligature, and cutting oflf one of the ends 
as causing less irritation and a more speedy separation, and allowing the bet- 
ter consolidation of the soft parts contiguous to the wound and its more rapid 
cicatrization. Some have advised the cutting ofl* both ends of the ligature to 
lessen the irritation, and to allow the whole extent of the wound to be united 

* To Dr. Edward Hartshorne, resident physician, under whose judicious charge the 
patient was placed, I am much indebted for the use of his copious notes. 

1843.] Peace's Ligature of Common Iliac Artery, 275 

by adhesion, and the ultimate discharge of the noose of the ligature by an 
orifice formed in the cicatrix. The inflammation that must supervene neces- 
sary to the displacement of the ligature is sometimes a cause of extensive 
abscesses, which of themselves may lead to secondary hemorrhage; and in a 
case like the present, where the ligature is deeply placed, what certainty have 
we that it may not take some unusual route, and during its progress of ulcer- 
ation involve some of the important organs in the neighbourhood? We have 
given a preference to a large ligature to allow sufficient time for perfect adhe- 
sion of the internal coats of the artery and the condensation of the fibrin of 
the coagulum preparatory to the total obliteration of its cavity. Both ends of 
the ligature were allowed to remain hanging together out of the wound, to 
give a free vent to any collection of pus that might take place, and far from 
having any fears from the irritation of the ligature, we permitted nature un- 
aided to throw it off only as fast as she filled the sinus from the bottom with 

Our line of incision was longer and more vertical, and was a modification 
of the operation of Sir Astley Cooper for the external iliac, but still retaining 
the great advantage of his method — that of the greater facility of separating 
safely the peritoneum, which consideration we think of the greatest impor- 
tance, on account of the danger of peritonitis and the prostration of the vital 
powers from the necessary handling of the intestines to prevent their inter- 
fering with the latter steps of the operation. In order to appreciate justly the 
danger from the application of a ligature to the primitive iliac, the following 
account of all the cases that have occurred is given. 

The^rs^ was an unfavourable case operated on by Prof. Gibson, in 1812. 
{Am, Med. Recorder, Jan. 1820, p. 185.) The patient had received a wound 
from a musket-ball, which passed through the intestines and opened the com- 
mon iliac; two ligatures were placed upon that vessel above and below the point 
of injury — the peritoneum was cut through in the operation. There was a 
fair prospect of recovery till the ninth day, when hemorrhage occurred and 
death took place on the fifteenth day. The intestines were glued to each 
other, bearing evident marks of peritoneal inflammation. The upper ligature 
was detached from the artery, the coats of which retained the impression of 
the ligature, but no union whatever had taken place. 

The second was a favourable case of external iliac aneurism, attributed to 
lifting heavy logs, operated on by Prof. Mott, of New York, and reported in 
the 1st vol. of this Journal, p. 15G. The peritoneum was not opened, liga- 
ture removed on the eighteenth day. The patient, a man 33 years of age, 
recovered perfectly. This was the first successful operation. 

The third was a favourable case of external iliac aneurism, operated on by 
Sir Philip Crampton, {Am.Journ, Med. Sc. Feb. 1831, p. 500,) unsuccessful. 
The peritoneum was not opened. On the ninth day the ligature of moistened 
catgut came away. On the eleventh day, whilst the patient, a man ast. 30, was 
sitting up to take some gruel, the blood gushed from the wound and death 

276 Peace's Ligature of Common Iliac Artery, [April 

ensued in less than a minute. Dissection disclosed that the internal and mid- 
dle coats had been completely divided, but the animal ligature had been soft- 
ened and thrown off before adhesion at the point of deligation had taken place. 

The fourth was an unfavourable case, occurring in a patient aetat. 8, who 
underwent an amputation for necrosis of femur, followed by secondary hemor- 
rhage. [Lond. Meet Gaz., April, 1830.) On the eighth day after amputation 
hemorrhage occurred, which could not be arrested by the usual applications. A 
ligature was applied by Mr. Liston, to the common iliac; the peritoneum was 
not opened; the hemorrhage was arrested, but the patient died in twenty-four 
hours, apparently from the previous exhaustion by loss of blood. 

The fifth was a favourable case, and successful as far as the operation was 
concerned. The subject of it was a lady, age not stated, with supposed gluteal 
aneurism, operated on by Mr. Guthrie. {Lond. Med. and Surg. Joiirn., Aug. 
1834.) The peritoneum was nicked accidentally, but the ligature was lied 
without passing through the peritoneum. The ligature came away on the 
twenty-sixth day, and was followed by a sensible diminution of the tumour, 
and a general amelioration of all her symptoms. At the end of four months 
the tumour began again to increase, and in eight months after the operation 
she died. On examination of the tumour, which occupied the whole hip, it 
proved to be composed of soft medullary matter, which had destroyed the 
bones, and in which the head of the femur was lying loose. On searching for 
an aneurismal sac none could be found, but the gluteal and sciatic arteries 
were traced into the medullary tumour, which gave it the pulsatory motion 
felt before the operation. At the conclusion of this instructive case, the author 
offers what appears to me a very valuable suggestion, viz. "That of tying the 
common iliac of the affected side, by making the incision through the opposite 
side, when the disease has extended too far up to allow of its being done 
above." I certainly should give a preference to an operation of this kind, in 
a case where it was thought impracticable to operate on the affected side 
without opening the peritoneal cavity. 

The sixth was a favourable case of external iliac aneurism, attributed to the 
kick of a horse, successful, operated on by Dr. Salomon, of St. Petersburg. 
{American Journ. Med. Sc. Aug. 1838, p. 474, and May 1840, p. 218.) 
The peritoneum not opened; no unfavourable symptoms, except superficial 
sloughs from the fifth to the tenth day on the outer side of the foot. Ligature 
came away on the thirty-second day, and at the end of two months the pa- 
tient, a man 38 years of age, was sent home well. Ten months after the 
operation he died of lumbar abscess. 

The seventh was an unfavourable case of external iliac aneurism, unsuc- 
cessful, in a man aetat. 31, operated on by Mr. Syme. {Am. Journ. Med. Sci. 
Feb. 1839.) Mortification of the leg below the knee had commenced, when 
it was resolved to tie the common iliac with the hope that after it v/as done, 
the process of mortification might be stopped by amputation of the thigh. 
Tumour had extended to within an inch of the umbilicus, and yet the ope- 

1843.] Peace's Ligature of Common Iliac Artery. 277 

rator with his curved incision had no difficulty in separating the peritoneum, 
though there was some embarrassment in passing the ligature. The tumour 
became smaller; the coldness and discoloration of the limb extended above 
the knee. On the fourth day, amputation of the thigh was performed, close 
above the discoloured part of the limb. The next day death took place. 

The eighth was a favourable case of aneurism of the external iliac, attri- 
buted to a violent exertion, successfully operated on by Deguise. [Gaz. Med. 
de Paris, May, 1840.) During the operation the aneurismal sac was 
opened. The hemorrhage was arrested by pressure upon the external 
iliac; it was then discovered that the artery had given way under the liga- 
ture. The common iliac was then tied. The peritoneum was not opened. 
Fearing that secondary hemorrhage might follow from the wounded sac, a 
ligature was placed around the femoral artery below the pubis, in doing 
which the vein was wounded, and had also to be secured. Notwithstanding 
these serious complications, the case terminated favourably. The ligfature 
of the femoral vein came away on the eighth day, that of the primitive iliac, 
the twenty-seventh, the external iliac on the twenty-ninth, and the femoral 
artery on the fortieth. 

The ninth was a case of external iliac aneurism, unfavourable, operated on 
by Dr. PirogofF. The latter part of this case is to be found in the New York 
Journ. of Med. and Surg. Jan, 1841, p. 235, taken from Zeitschrift fur die 
gesammte Medicin; but the translator has not given the date, and 1 have not 
been able to find the original report. On the sixth day after a ligature was 
placed upon the external iliac, it came away with a portion of sloughing 
cellular tissue with secondary hemorrhage. An incision was made above 
the former one; but when the peritoneum was exposed, it was found to be so 
adherent in the neighbourhood of the first wound, that it was torn by the 
finger, and a second time over the artery, to apply the ligature. On the 
eighth day the wound became gangrenous. On the fifteenth, arterial he- 
morrhage occurred, and on the following day he died. Above the ligature 
was a coagulum partly of blood and partly of lymph, three-quarters of an 
inch in length, loosely adhering to its inner coat. This clot was broken 
through at a small spot, from which undoubtedly the hemorrhage occurred. 

The tenth case occurred in a man aet. 20, with aneurism of the external iliac, 
operated on by Dr. Alfred Post. {N. Y. Med. Sf Surg. Jour. Oct. 1 840, p. 459.) 
This case was rendered unfavourable by the difficulty of forming an accurate 
diagnosis. Nine days after the entrance of the patient into the hospital, a lancet 
was introduced into the tumour to the depth of an inch, but no fluid escaped. 
An explorative incision was made through the integuments covering the tu- 
mour, sufficient to admit the tip of the finger into a cavity containing coagulated 
blood, and a compress was applied. In the night there was a gush of a pint of 
arterial blood which was arrested by a compress and an appropriate bandage. 
On the next day, a ligature to the primitive iliac was determined upon, but 
the patient would not consent to this till the next day, when his surgeons 

278 Peace's Ligature of Common Iliac Artery, [April 

deeming it impracticable to expose the iliac artery without opening the peri- 
toneal cavity, a vertical incision six inches in length was made through the 
abdominal parieties and peritoneum, and the ligature applied. The pain was 
greatly relieved, but he gradually sank, and died in twenty-four hours after 
the operation. The death of the patient was attributed to exhaustion from 
severe and long continued pain, loss of blood following the explorative inci- 
sion, and the superadded shock of the last operation. 

The eleventh was a case of external iliac aneurism, in a man, operated 
on by Dr. Stevens, in 1836, at the New York Hospital. The case has 
never been reported. Dr. Norris, to whom the surgical world is already 
indebted for so much valuable statistical information, informs me that the 
man died ten days after the operation, of peritonitis. The preparation is pre- 
served in the museum of the hospital. 

These, with the case here given, make twelve cases in which the primitive 
iliac ^as been tied, of which five were successful, and seven unsuccessful. 

In three cases not aneurismal, two were unsuccessful, and one, the case of 
medullary sarcoma, successful. 

Nine were cases of aneurism of the external iliac, all males — six of the 
right side, two of the left, and one not given. The ages of seven that are 
noted are between the ages of twenty and forty-two, of which five are between 
those of thirty and forty. No assignable cause is given but in four cases; 
three are attributed to lifting heavy loads, and one to the kick of a horse. 
The sex, the age, and causes assigned are in accordance with the opinions 
commonly received of the history of aneurism. 

In the nine cases of aneurism, four were cured, and five died. Of the five 
favourable cases, (viz. those of Mott, Crampton, Salomon, Deguise, and the 
present case,) by which we mean aneurisms without any complication previous 
to the operation, four were cured, one only died, and that must be attributed 
to the use of the animal ligature. In neither of these cases was the perito- 
neum opened. 

We have placed the case of Dr. Stevens among the unfavourable ones, 
judging rather from, the result than from sufficient knowledge of the circum- 
stances attendant upon the case. If we omit this, which proved fatal from 
peritonitis, we have three unfavourable cases terminating fatally, in two of 
which the peritoneum was opened. We therefore come to the conclusion, 
that in a case of aneurism of the external iliac artery in its early stage, and 
where we are not obliged to cut the peritoneum, the application of a ligature 
to the common iliac artery is not a very dangerous operation. 

1843.] Gardner on the Active Principle of Malaria, 279 

Art. II. — On the Active Principle of Malaria, By Daniel P. Gard- 
ner, M.D., Professor of Chemistry, &c. in Hampden Sidney College, 
Va. &c. 

The subject will be discussed in the form of propositions, for the better 
classification of details. The profession are therefore made the judges in the 
matter, and their acceptance or rejection of the arguments brought forward, 
will substantiate or destroy the theory advocated in the following pages. 
The propositions, under which the facts adduced to show the nature of the 
active principle of malaria are classified, are: 

1st. Sulphuretted hydrogen gas exists in the stagnant waters, and atmo- 
sphere of certain marshes. 

2d. The character of malarious regions is similar to that of those in 
which sulphuretted hydrogen is generated. 

3d. Certain agents have been supposed to give activity to the exhalations 
arising from marshes, called malaria. 

4th. The properties of malaria are fully recognised by the profession. 

5th. Sulphuretted hydrogen is the active agent in the production of those 
forms of malarious fever met on the sea coast, and the diseases belonging to 
the same class found inland. 

Proposition I. Sulphuretted hydrogen gas exists in the stagnant waters, 
and atmosphere of certain marshes. 

1. Numerous conjectures have been made concerning the cause of malaria. 
Nearly every agent, from carbonic acid to certain theoretical germs, have 
been brought forward as the deleterious matter. Amongst these, sulphu- 
retted hydrogen has occupied a prominent position. But all attempts to 
demonstrate its existence had failed, until Professor Daniel, in 1841, suc- 
ceeded in detecting large quantities of the gas in some specimens of water, 
submitted to his notice by the British admiralty for analysis. These speci- 
mens were from the African rivers Bonny, Sierra Leone, Mooney, Congo, 
and the adjacent seas. Mr. Garden,, of London, also found the same gas in 
water from the Bonny and Lagos. Dr. Marcet, in the Yellow seas. All 
these localities are reputed for their insalubrity, and it was natural to attribute 
to the gas some share in producing it. 

2. Bui it is not only on the pestiferous shores of Africa that malaria exists. 
Practitioners in the United States have designated numerous localities which 
are remarkable for the peculiar diseases attributed to malaria. It becomes 
therefore an interesting question to ascertain whether sulphuretted hydrogen 
exists in all these places. The labour of one individual is not competent to 
the task, but it may become the lot of one to direct the attention of the pro- 

280 Gardner on the Active Principle af Malaria. [April 

fession, and put into their hands the means of deciding this much vexed 
and important question. 

3. The difficulty, which has been found insuperable, in testing for this gas, 
is the extremely small quantity in which it exists in the air. A sufficient 
bulk of atmospheric air could not be submitted to examination to detect its 
presence. But instead of securing specimens from marshes, it appears ex- 
traordinary, that until very lately, the air or at least the stagnant water had 
not been examined on the spot. With a view of effecting this examination, 
I considered how an apparatus might be constructed to allow large volumes 
of gas to pass constantly across some reagent calculated to detect sulphur. 
The fruit of my labours was unsatisfactory, and I was reduced to the neces- 
sity of bringing the reagent simply in contact with the air, and water, with- 
out being able to increase the quantities of the former coming direcdy across 
it. The substance best calculated to answer all the necessary indications is 
silver, which when properly prepared is an exceedingly delicate test for sul- 
phur, and not liable to be attacked by the many agents which act upon 
lead, copper, &;c. 

4. The silver must present a pure surface. To effect this, it should be 
kept in contact with a boiling solution of caustic potash and alum. The pro- 
cess must be continued through one or two changes of the solution, if the 
metal be very unclean. The last should be evaporated to dryness, for by 
this means the potash is made to act upon any copper that may be present 
as an adulteration. When the process has been successful, the silver pre- 
sents a granulated surface of a dull lustre, and immaculate purity. 'J'he coins 
in circulation are beautifully cleaned by this method, and become as good 
reagents as any other pieces of silver. They were used in the experiments 
instituted by myself. 

5. The delicacy of pure silver as a test for sulphuretted hydrogen is ex- 
ceedingly great. A solution was made containing one drop of hydrosulphate 
of ammonia in 120,000 grs. of water. A five cent piece placed in it was 
discoloured in the course of a few minutes, and became of a decided light 
yellowish brown colour in two hours, without agitation. This is by no 
means the minimum which it will detect. The amount of sulphur present 
in the solution was determined by precipitating the whole of that substance 
out of a known quantity of the hydrosulphate by means of the nitrate of lead, 
collecting the precipitate, washing, drying and weighing it; allowing the in- 
gredients of the sulphuret of lead to be in the ratio of their equivalents, or 
as 104 to 16.1, the quantity of sulphur present in a drop was found to be gV^h 
of a grain. So that metallic silver, perfectly pure, is able to detect sulphur 
in a solution containing one part in three millions of water. As a means of 
determining the amount of sulphuretted hydrogen in mineral waters it is 
without comparison the best test, for all the addition to the weight of the 
silver is pure sulphur, and the metal is not acted upon by carbonic acid> 

1843.] G^xdiwex on the Active Principle of Malaria. 281 

which is nearly always present, and difficult to separate from the sulphu- 
retted hydrogen. 

6. Having learnt the delicacy of silver, it appeared to me, that by long 
exposure to the action of the water, and air of marshes, it might become 
stained by sulphuretted hydrogen, if that gas existed in such places. Ac- 
cordingly, a number of prepared coins were disposed in suitable positions 
for its detection. Three small rivers, Buffalo, Briery, and Appomattox were 
selected, and coins suspended in them by a stout silk thread, passed through 
a perforation made in them before cleaning; the stagnant water lying upon 
the surface of marshes, and produced by sluggish springs, was also tested in 
the same way, not allowing the metal to touch the soil, but suspending it 
from the branches of shrubs. The currents which set out from cold springs, 
and which are known in the country as spring branches, were also examined 
in the same way, at different points from their origin. In the air, over rivers, 
and marshes, coins were exposed. Tiie description of money used was 
various, five cents, ten cents, twelve and a half cents, and twenty-five cent 
pieces were all taken, according to the change in my possession. They 
were first perforated in a marked place, so as to be recognised, next cleaned 
and dried, then carefully weighed, furnished with a string, and lastly carried 
to the place selected. Great care was taken to keep the surface unsullied by 
the touch of the finger or otherwise. The number of pieces used was thirty, 
and all the suspected places within a circle whose diameter is seven miles 
were examined. 

7. In twenty-two hours after the first set of these coins were deposited, 
two were found distincdy stained, one in a marsh, and the other in a spring 
branch flowing through a marshy piece of land, and receiving constant addi- 
tions of stagnant water from it. Two other coins immersed for the same 
time in the Buffalo river exhibited no sign of change. This great difference 
is worthy of remark, and points out the locality wherein the gas is generated. 
It was found to be a law, from repeated examination, that the shallow waters 
of marshes contained the most, and rivers the least amount of gas; the coins 
placed in the latter sometimes required a month, and those suspended in air 
even more time for discoloration. In all the experiments I made, the silver 
was ultimately stained. 

8. The discovery of sulphuretted hydrogen in the air, is a new and im- 
portant feature of these researches. In one coin placed over the Buffalo 
river it required five weeks to produce the sulphuret stain, but a quarter of a 
dollar suspended eighteen inches from the soil, in a marsh over stagnant 
spring water, was discoloured in a week. In every case where the gas was 
detected rapidly in water it was found in the air over it, in a greater or less 
time. This must necessarily be the case, for a solution of sulphuretted hy- 
drogen exposed to the atmosphere must continually give off that gas, by 
exosmose, until the air and water contain equal quantities. Hence the gas 
abounds where it is generated, both in the air and water, and diminishes in 

282 Gardner on the Active Principle of Malaria. [April 

quantity as the distance increases from the place of its production. That 
sulphuretted hydrogen exists in air must be admitted, when the discolora- 
tion of white lead paint in cities is considered; the houses painted with it in 
London, and Paris, become of a light dingy yellow in a few years. Plate, 
and other silver wares lose their polish and become tarnished in houses. 
These changes are undoubtedly due to sulphur existing in the atmosphere of 
such places. 

9. That the discoloration observed in the coins was due to the formation 
of a sulphuret was proved directly by the reduction of the silver. Two 
pieces were selected, and weighed, after an exposure of ten days. They 
had both acquired -j-f oths of a grain access of weight, but as their diameters 
were not similar, the increase was not in the ratio of their surfaces, but as 
26 to 35. This was due to the difference of the places from which they 
had been taken, the one from a marsh, the other from a spring branch. The 
process adopted for the detection of sulphur on the coin, was by passing a 
stream of hydrogen gas, over the metal inclosed in a green glass tube, and 
made red hot; the effluent gas discoloured nitrate of silver in the manner of 
sulphuretted hydrogen. 

10. Having proved that sulphur exists in these localities, my next object 
was to examine the causes of it. In the foregoing experiments, the imme- 
diate source was a marsh, containing much decaying vegetable matter, a rich 
alluvial soil saturated with spring water, or that which had percolated through 
the soil, and heated by the temperature of midsummer. These four condi- 
tions are all worthy of examination. 

11. Alluvial deposits contain much vegetable matter, their blackness is due 
to it in some measure. This vegetable matter is in a constant state of de- 
cay, the rapidity of which is proportional to the access of oxygen, and the 
warmth of the season. Such accumulations are therefore interesting, as 
laboratories in which powerful affinities are bringing about numerous striking 
changes. They form the scene of many important events worthy of close 
attention. Let a sulphate be brought within the reach of these powerfully 
deoxidizing masses, and it will be decomposed by the destruction of its 

12. The second element, of the sites in which sulphuretted hydrogen was 
detected by me, is decaying vegetation. The effect of this, differs in no wise 
from the action of the organic constituents of alluvion. In its decay, carbon 
is left in excess, and exerts all its powerful affinities to assume the gaseous 
form. But vegetables contain certain inorganic constituents, which are of 
considerable interest in the changes under contemplation. Of these, the 
sulphates of lime, soda, potassa, and magnesia have been detected. In the 
decay of a plant containing any of these salts, the results will depend upon 
the presence or absence of water. If dry, they will be unchanged; but if 
water and heat be present, the sulphuric acid will be decomposed. The leaf 
contains a large proportion of the salts existing in a plant. 

1843.] Gardner on the Active Principle of Malaria, 283 

13. But of all the agents discovered in these localities, spring water is the 
most important. It is usually impure. It contains the soluble salts of the 
land through which it has percolated. These must from the nature of the 
case differ. Muriates, sulphates, phosphates and carbonates have been found 
by different analysts. Spring water is seldom free from sulphate of lime, or 
magnesia — the former imparts to it the quality denominated hardness. When 
these ingredients are present in any quantity, and the water is kept in contact 
with decaying vegetable matter, they are decomposed, oxygen is abstracted 
and sulphurets are produced — the latter in their turn, yield sulphuretted hy- 
drogen with the first nascent hydrogen they encounter. The final compound 
of these bases, is most probably a carbonate. That sulphuretted hydrogen 
is thus produced, is a matter of demonstration. Prof. Daniel put decaying 
leaves together with water containing sulphate of soda in a jar, and sub- 
jected them to the action of a summer's heat; in three months, sulphuretted 
hydrogen was abundantly given off, and the salts decomposed. If no sul- 
phate be present, either in the vegetable matter or water, the gas will not 
be given off. Hence, to apply the result of this decisive experiment to our 
purpose, no locality, the soil of which is destitute of the sulphates, can gene- 
rate the deleterious gas. 

Thus we have reached a generalisation which is indisputable, and of the 
greatest practical importance. For it affords the means of discriminating, 
even in the most unpromising situations, between a healthy and insalubrious 

To ascertain the presence of sulphates, the addition of a few drops of a 
solution of chloride of barium is all that is necessary. If the cloudy pre- 
cipitate that falls is unsatisfactory, boil the spring water until it is evaporated 
to a small compass, and test again. If a sulphate be present, the white, 
dense sulphate of baryta will fall, a salt that cannot be mistaken from its 
litter insolubility. This test is so simple, that any member of the profes- 
sion can decide upon the existence of sulphates, and therefore of sulphuret- 
ted hydrogen, in any place whatsoever. The test for the gas detailed in 
sections 4, 5, 6, is not less simple, and therefore, there are placed in his 
hands both the theoretical and experimental means of deciding on this grave 
question, at all times. 

It is also a fact, no less valuable than the preceding, that the practitioner 
is enabled to decide, by analysis, the comparative amount of the delete- 
rious gas in different situations. It is not extent of surface, depth of soil, 
geological structure, or the amount of evaporating water that concerns him, 
but the quantity of the sulphates. This point I have had the means of ex- 
amining, during several years, in consequence of the analysis of many spe- 
cimens of sulphur, and other mineral waters, from the counties of Prince 
Edward, Cumberland, Buckingham, Lunenburg, and Halifax in this state. 
Those waters, containing the greatest amount of the sulphates, yielded 
larger quantities of sulphuretted hydrogen than those which contained but 

284 G^x(\ner on the Active Principle of Malaria. [April 

little of these salts. All the specimens of sulphur water, examined by me, 
■were from alluvial deposits. Two saline waters contained sulphate of mag- 
nesia and lime, but they were procured from rocky places, in which no 
vegetable matter existed. Three specimens were from alluvial situations, 
but contained no sulphates, and therefore no sulphuretted hydrogen gas. 
But {e\Y mineral waters, are as rich in sulphates as the ocean. Schweitzer 
found in 1000 grs. of water from the British Channel, 3.7 grs. of sulphate 
of lime, and magnesia. Laurens 7.17 grs. in the same bulk from the Medi- 
terranean. Murray, in a wine pint, 21.6 grs. of sulphate of magnesia. Prof. 
Daniel, from 80 to 120 grs. of sulphuric acid in a gallon of the waters from 
the African coast. The sea stations are the most dangerous, when vege- 
table matters are present, as on alluvial coasts; but the open expanse of old 
ocean is without the least trace of malaria. Rivers, before they become salt 
by contact with the ocean, contain less saline matters than marshes, in con- 
sequence of the showers of rain water which reach them without percolating 
the soil and dissolving out the sulphates incorporated in it. 

14. The temperature must be warm, for the production of these changes 
in the sulphates. The amount of heat necessary to commence the decom- 
position is unknown, and can be determined only by experiment. It is 
known to be above the freezing point, for water is necessary. An elevated 
temperature is highly favourable, and the more elevated, so long as water 
remains, the more favourable it is for the production of the gas. This is an 
immediate consequence of chemical laws, and is further borne out by the 
quantities of sulphuretted hydrogen discovered in the tropical waters of 
Africa and China. In the same proportion, the fatality of malarious diseases 
increases. Temperature is, therefore, an element in our researches, not to 
be overlooked. 

15. It is not to be understood, that because sulphates are found in certain 
waters, the gas must exist in them also — for it is not the presence of one 
condition, but of all, that produces the results under consideration. So sul- 
phuretted hydrogen may be found in waters which contain no sulpliates — 
this appears to be the case in the mineral waters of Aix la Chapelle analysed 
by Bertrman; Moffat by Garnet, and Harrowgate in England. Such excep- 
tions point out to our attention, the existence of other sources of the gas. 
It is believed that at Harrowgate, the destruction of large quantities of py- 
rites yields it; the iron combining with oxygen gives up its sulphur to nascent 
hydrogen. Other minerals, and districts may yield the gas, without dispa- 
ragement to the fact adduced. As far as ray examinations in Virginia go, I 
believe that sidphuretted hydrogen is produced in springs by the process 
under examination. Dr. Amedee Fontm suggests the i-anie process as 
yieldmg the gas in the waters of Germany, Belgium, Switzerland and Savoy. 

16. Thus, having proved that sulphuretted h) drogen exist in the air, and 
water of marshes — having showed the isi al sources of this si bstance, and 
the process by which it is eliminated — it remains to show that the localities 

1843.] Ga^i^nev on the Active Principle of Malaria. 285 

which are remarkable for the production of malaria agree with those fitted to 
•generate the gas. The circumstances under which sulphuretted hydrogen is 
most abundantly produced are — sufficient water not to dilute the gas, expo- 
sure of the soil to the air, high temperature, and abundant supplies of vege- 
table matter and soluble sulphates. Hence sea-marshes, the deltas of tropical 
rivers containing salt water, &c. exposed to certain states of drought, are the 
most prolific sources of sulphuretted hydrogen and malaria. Nor is the 
bilge water of ships, in contact with decaying wood, or other vegetable mat- 
ter, to be overlooked. 

Proposition II. — The character of malarious regions is similar to that 
of those in which sulphuretted hydrogen is generated. 

17. In a narrative of an expedition into the interior of Africa, along the 
river Niger, by Messrs. Laird and Oldfield, the following remarks occur. 
*' The principal predisposing causes of tlie awful mortality, were in my opin- 
ion the sudden change from the open sea to a narrow and winding river, the 
want of the sea-breeze, and the prevalence of the deadly miasma, to which 
we are nightly exposed from the surrounding swamps. The horrid sicken- 
ing stench of the miasma must be experienced to be conceived." In water 
taken from this spot Mr. Daniel found sulphuretted hydrogen. In some of 
the specimens there were 6.7 to 11 cubic inches of it in a gallon. 

18. From the same narrative, it appears, that sickness attacked the vessel 
twenty-seven days before their entrance into the river Nun. In removing a 
part of the cargo, it was discovered that the cause of a " disagreeable va- 
pour, from which they had long suffered, was, that the bags containing the 
cocoa had rolled, and the cocoa had fallen into the salt bilge water and there 
become putrid." 

19. The following account is extracted from Dr. Harrington's paper. The 
Hornet had been "salted," and was consequently very damp. When she 
was " broken out" at New York, after her return in 1828, great quantities 
of mud, and other filth were taken from her hold; and in her timbers and 
lower works was discovered a considerable collection of chips and shavings 
in a putrid state. The bilge water, and smell from the hold in this vessel 
were exceedingly unpleasant. On board this ship, yellow fever made its ap- 
pearance whilst ofl' Sacrificios, Mexico. The Peacock, which suffered 
also, was in much the same condition. The temperature averaged 84^ F. 
This writer states, that "by experiments made on shipboard, 17 grains of 
chloride of lime decomposed all the sulphuretted hydrogen in half a pint of 
bilge water." [Am. Journ. Med. Sci. Aug. 1833, p. 307, et seq.) 

20. New Orleans " is built on a soft alluvial soil, but a few feet above the 
water in the wells, the dampness is consequently very great; the streets are 
filthy." The attack of " Epidemic Yellow Fever of the autumn of 1833" 
is described by Dr. E. H. Barton. August — rain 8.17 inches; average 
thermometer 79.97 rising to 90° F., at midnight often 81°— 84°. "From 
No. X.— April, 1843. 19 

286 Gardner on the Active Principle of Malaria. [April 

the streets arose a very offensive odour." The streets were filthy and exhaled 
a peculiar offensive odour after rains. This writer quotes the tables of Phi-' 
ladelphia, and the authority of Sir G. Blane and M. Arejula, to prove that 
the fever does not occur at a lower temperature than 79° — 82° F. (^m. 
Journ. Med, Sci. Nov. 1834.) 

21. On the north side of Mobile, " the land is wet and swampy, consist- 
ing of a soft black mud, apparently without any solid foundation." " Per- 
sons residing there throughout the year, will be liable to the different grades 
of bilious or endemic fever of either the intermitting, remitting, or continued 
type." The well water is warm and brackish. The coast bordering the bay 
is considered unhealthy — " the sea-breeze blows over a quantity of decaying 
drift wood, and other perishable matters." Spring Hill being entirely free 
from stagnant water is healthy," Dr. Heustis, from whom the above facts 
are taken, remarks " that a range of temperature from 70° to 80° F. is 
necessary for the production of bilious endemic, or yellow fever — it should 
not fall below 70° at night, or 86° in the day." {Am. J. Med. Sc. Nov. 1836.) 

22. Dr. Lucas gives an admirable account of the topography, and diseases 
of Montgomery county, Alabama, in the American Journal of the Medical 
Sciences, Nov. 1827, in which the same causes are pointed out as the pro- 
ducers of malaria, that are requisite for the evolution of sulphuretted hydrogen. 
Alluvial soil, vegetable decay, and high temperature are found in the most 
healthy parts. 

Dr. Heustis introduces similar local causes to account for the autumnal re- 
mittent of Dallas county in the same state. {Am. Journ. Med. Sci. Feb. 1832.) 

23. Charleston, South Carolina, has been visited by repeated attacks of 
yellow fever. One of 1827 is fully described by Prof. Dickson in the Ame- 
rican Journal of t lie Medical Sciences, May, 1828. The city stands on a 
neck of land between two marshy rivers, the commercial part is built on 
alluvial soil; some of which is "made," having been formerly covered by 
creeks which intersected it in every direction. The materials used for fill- 
ing up low swampy lots, are principally pine logs, oyster-shells, and rubbish 
of all kinds, and even scavengers' offals. The wharves are of wood filled up 
with those materials, and with mud drawn from the river. " You will rea- 
dily infer that grounds thus made will be eminently fitted for generating, and 
giving off deleterious effluvia." The thermometer ranged from 82° to 90° 
in August, in the sun it reached 120° — 125° — 130° F., and at 2 o'clock 
A. M. with every door and window open, 86° F. This writer, as well as 
Dr. Lucas, remarks that negroes escape often in the most unhealthy seasons. 

Dr. Simmons, in a report on Yellow Fever, read in 1839, remarks: 
*' Stranger's fever requires a high temperature, ranging 85° F. — it is ac- 
companied with moisture. In the docks (of Charleston) a good deal of 
mud, with decomposed vegetable, and other materials are thrown up by the 
tide, and at low water, the exhalations are offensiA'-e. At present the city is 
surrounded by marshes through which the salt water ebbs and flows." [Am, 
Journ. Med. Sci. Feb. 1840, p. 409.) 

1843.] GTiY^nex on the Active Principle of Malaria. 287 

24: Augusta, Georgia, was visited by a severe endemic in 1839. A re- 
port, drawn up by a committee of physicians, attributes it to the exhalations 
given off from about 117,000 to 200,000 cubic feet of decaying animal and 
vegetable matter collected at the trash way, and reposing on the bed of the 
river, above tjie surface of which it rose. [Jim. Journ. Med. Sci. Feb. 1840, 
p. 410.) 

25. Dr. Hildreth, treating of the climate of Washington county, Ohio, 
remarks: " In 1807 the alluvial low grounds near the river, were inundated. 
In 1822, the water of the rivers and creeks was low, stagnant and putrid — 
the Ohio for two or three months resembled a long slimy lake." In 1823 
the low grounds were deluged. [Jim.Joiirn. Med. Sci. Feb. 1830.) 

26. Batavia, the storehouse of pestilence, is thus described by Dr. Bettner. 
The islands in front of the harbour (used as cemeteries) obstruct the free 
passage of the sea-breeze, and contribute to the stillness of the water in the 
roads, which sometimes appears thick and partly stagnant;, "imparting an 
unpleasant and unwholesome odour." " This atmosphere receives still further 
contributions from the canals of the city, and the surrounding marshes, and 
jungles." The coast is alluvial — nights sultry and moist, range of the ther- 
mometer 90'' F. (./?m. Journ. Med. Sci. Aug. 1830, p. 380.) 

27. St. Lucia is a small volcanic island, containing rich alluvial valleys, 
with morasses. The tropical vegetation accumulates large stores of decay- 
ing matter in the putrid swamps. Dr. Evans calls the exhalations from the 
marsh of Castries, deleterious; he smelt a disagreeable odour in crossing it, 
and was soon after taken with nausea, &c. 

28. Smyrna is built on an alluvial plain, always moist. A sulphur spring 
exists near the town. Its commonest diseases are miasmatic fevers. 

29. Mr. Darwin remarks that in certain parts of Peru, the sulphates of 
magnesia and soda effloresce upon the soil, and the mud of the neighbour- 
ing saline lakes is black and fetid. That the worst attacks of ague occur 
here, whereas in Brazil many marshes with rank vegetation, exposed to 
ardent heat, are more healthy. 

30. Certain marshes, at the foot of tlie Ligurian Appenines, were until 
1741 exposed to an occasional influx of the sea, which, coming in contact 
with their decaying vegetable matter, produced the most deadly miasm. In 
that year the sea was shut out, and although the fresh water of the marshes 
stagnates, they have not since thrown up any malaria. 

The same is true of the basins of Motrone, and Perotto. (See a paper 
by Signor G. Giorgini, Annates de Chemie, vol. 29.) 

31. The intrusion of salt water into the marshes of Caitia, near Vene- 
zuela, produces the most fatal consequences. " So that negroes escape there, 
to avoid the attacks of the whites, as none dare to follow." Chagres owes 
its insalubrity to the surrounding swamps. 

All the coasts on which mangroves flourish, are dangerous. The recess 
of the tide exposes to the air extensive surfaces of decaying vegetable matter, 

288 G-^ivdner on the Active Principle of Malaria. [April 

acting on the sulphates of the sea water, and throwing into the air volumes 
of sulphuretted hydrogen. The deadly malaria of the South Carolina rice 
fields is produced by letting in the sea water to the young plants, by which 
the weeds infesting the rich alluvial grounds are destroyed, and abundance 
of sulphuretted hydrogen produced. 

32. The places enumerated, with numerous others, in which bilious en- 
demics occur, are characterized by the requisites for the generation of sul- 
phuretted hydrogen gas. The worst fevers prevail on alluvial sea-coasts, 
and yellow fever seldom attacks any other places. The cases 17, 18, 19, 
29, 30, 31 are sufficient to establish the present proposition, but the argument 
may be further fortified by the examination of certain places which have 
ceased to be unhealthy. 

33. There is none perhaps more remarkable than the city of Calcutta, 
which, at first founded on a salt marsh, was deadly to Europeans. But the 
talents and industry of its colonists have rendered the place healthy by 
draining, cleaning,-, and paving it thoroughly. The fate of Fultah, below 
Calcutta, is diflferent; from being the abode of luxury, it has relapsed into its 
primeval condition of a marshy jungle, where fever and pestilence prevail. 

34. New York, before its marshes were filled up with the red sandstone 
detritus of the island, was liable to severe remittents. European writers on 
malaria speak to the present day of the yellow fever of that city. 

Norfolk, Va., has rapidly improved in health, since the better paving of the 

35. Panama, once subject to the severest fevers, has become healthy by 
the destruction of the neighbouring forests. 

36. We find also, that in those localities where one, or all the conditions 
necessary for the production of sulphuretted hydrogen are absent, malaria 
does not exist. Such is the case in Malta; the plains of Russia; the Sand- 
wich islands; Gibraltar; the elevated plains of the Andes, and Mexico; table 
lands — of this kind is the western part of the state of Pennsylvania, reputed by 
Dr. Callaghan (.^m. Journ. Med. Sci. Nov. 1828) to be free from all malaria; 
sandy deserts as those of Africa and Arabia; the pine